Individual
KATHY NICKI MENCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
559 CAPITOL BLVD, SAINT PAUL, MN 55103-2101
(651) 232-2000
(651) 232-2118
Mailing address
8838 LAKE JANE TRL N, LAKE ELMO, MN 55042-8518
(651) 770-5258
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R078147-1
MN
Other
Enumeration date
08/16/2006
Last updated
07/08/2007
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