Provider Demographics
NPI:1447830153
Name:KAISER, PATTI JO (RN, DNP, APRN, FNP-B)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:JO
Last Name:KAISER
Suffix:
Gender:F
Credentials:RN, DNP, APRN, FNP-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 RESERVOIR BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3255
Mailing Address - Country:US
Mailing Address - Phone:763-782-1611
Mailing Address - Fax:
Practice Address - Street 1:4444 RESERVOIR BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3255
Practice Address - Country:US
Practice Address - Phone:763-782-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8025363LF0000X
MN1056202163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily