Katherine Wahl

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

6045 Issued in MN

Practice address

13980 Northdale Blvd
Rogers, MN 55374

Phone

(763) 428-1920

Fax

(612) 874-2916

NPI assigned

Jan 19, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Partners in Pediatrics, LTD.

  • Pediatrics Physician
  • Maple Grove, MN
  • NPI 1487604104
  NPD (past)
• Rosenberg Center Assessment and Treatment for Children & Families PA

  • Developmental Disabilities Clinic/Center
  • Roseville, MN
  • NPI 1033347331
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542326400000",
    "number": "1609384973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13980 NORTHDALE BLVD",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553742147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13980 NORTHDALE BLVD",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "55374",
            "telephone_number": "763-428-1920",
            "fax_number": "612-874-2916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554151623",
            "country_code": "US",
            "telephone_number": "612-873-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAHL",
        "first_name": "KATHERINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-19",
        "last_updated": "2018-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "MN",
            "license": "2230470",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "6045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Unity Autism Solutions LLC
• Valkyrie Relocation LLC
• Suzy Yang Vang
• Antoinette R Vanstelten, PSY D
• Emily Volinkaty
• Sarah J Walentiny
• Walgreen Co (Walgreens #07812)
• Walkoviak Optometry LLC
• Ashley Walkoviak, O.D.
• Laura Wallace, CNP, DNP-FNP

• Pediatric Nurse Practitioner in Rogers, MN
• Providers in Rogers, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.