Individual
KATHLEEN MCDONOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
525 PORTLAND AVE, MC: 952, MINNEAPOLIS, MN 55415-1533
(612) 348-3033
(612) 348-7818
Mailing address
525 PORTLAND AVE, MC: 952, MINNEAPOLIS, MN 55415-1533
(612) 348-3033
(612) 348-7818
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
0929194
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0700840
MEDICA
MN
01
—
11F35MC
BLUE CROSS/BLUE SHIELD
MN
01
—
127557
UCARE
MN
01
—
6982979
EVERCARE
MN
01
—
971465100
MEDICAL ASSISTANCE
MN
01
—
HP29918
HEALTHPARTNERS
MN
Enumeration date
07/25/2006
Last updated
07/08/2007
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