Individual
KATHY DETKE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1451 44TH AVE S, GRAND FORKS, ND 58201-3434
(701) 738-2004
Mailing address
1451 44TH AVE S, GRAND FORKS, ND 58201-3434
(701) 738-2004
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R18078
ND
Other
Enumeration date
05/25/2006
Last updated
07/08/2007
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