Provider Demographics
NPI:1386964138
Name:RATH, MANDY KAYE (FNP, MSN, BSN)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:KAYE
Last Name:RATH
Suffix:
Gender:F
Credentials:FNP, MSN, BSN
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:KAYE
Other - Last Name:BINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 W BROADWAY
Mailing Address - Street 2:PO BOX 54
Mailing Address - City:STEELE
Mailing Address - State:ND
Mailing Address - Zip Code:58482-7109
Mailing Address - Country:US
Mailing Address - Phone:701-475-2910
Mailing Address - Fax:701-475-2815
Practice Address - Street 1:110 W BROADWAY
Practice Address - Street 2:BOX 54
Practice Address - City:STEELE
Practice Address - State:ND
Practice Address - Zip Code:58482-7109
Practice Address - Country:US
Practice Address - Phone:701-475-2910
Practice Address - Fax:701-475-2815
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR28545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily