Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP 0382 | MN |
N | 363L00000X | Nurse Practitioner | R204163-0 | MN |
NPI | 1013077304 |
---|---|
Provider Name | Katrina L Gabelko |
First Address | Rochester, MN 55904-4717 |
Second Address | Rochester, MN 55904-4717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2006 |
Last Update Date | 01/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |