Individual
KATHRYN G JUSTESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5502 W BROADWAY AVE, CRYSTAL, MN 55428-3508
(763) 504-6500
(763) 504-6544
Mailing address
5502 W BROADWAY AVE, CRYSTAL, MN 55428-3508
(763) 504-6500
(763) 504-6544
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42665
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
762695900
—
MN
Enumeration date
11/03/2005
Last updated
06/03/2010
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