Provider Demographics
NPI:1194880591
Name:HUNTINGTON, KATHERINE J (PAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:HUNTINGTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 BLOOMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1715
Mailing Address - Country:US
Mailing Address - Phone:612-721-6511
Mailing Address - Fax:612-721-0239
Practice Address - Street 1:3017 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1715
Practice Address - Country:US
Practice Address - Phone:612-721-6511
Practice Address - Fax:612-721-0239
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8945363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical