Provider Demographics
NPI:1447969266
Name:DOCKTER, KATHERINE CONDOR
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CONDOR
Last Name:DOCKTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 17TH ST E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2195
Mailing Address - Country:US
Mailing Address - Phone:012-698-9717
Mailing Address - Fax:
Practice Address - Street 1:2310 4TH AVE N
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2473
Practice Address - Country:US
Practice Address - Phone:218-422-7427
Practice Address - Fax:218-422-7427
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker