Individual
MS. KATHLEEN J LIETZAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APCNS
Contact information
Practice address
6950 146TH ST W, SUITE 100, APPLE VALLEY, MN 55124-4513
(952) 432-1484
(952) 432-2328
Mailing address
3100 W LAKE ST, SUITE 210, MINNEAPOLIS, MN 55416-4527
(612) 925-6033
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
R94581-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
392143300
—
MN
Enumeration date
12/14/2005
Last updated
08/14/2013
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