Kathleen J Lietzau, APCNS

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

R94581-9 Issued in MN

Practice address

6950 146TH St W
Suite 100
Apple Valley, MN 55124-4513

Phone

(952) 432-1484

Fax

(952) 432-2328

NPI assigned

Dec 14, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376438400000",
    "number": "1730164567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 W LAKE ST",
            "address_2": "SUITE 210",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554164527",
            "telephone_number": "612-925-6033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6950 146TH ST W",
            "address_2": "SUITE 100",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551244513",
            "telephone_number": "952-432-1484",
            "fax_number": "952-432-2328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIETZAU",
        "first_name": "KATHLEEN",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "APCNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-14",
        "last_updated": "2013-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MN",
            "license": "R94581-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "392143300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Psychiatric/Mental Health Registered Nurse in Apple Valley, MN
• Providers in Apple Valley, MN by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; 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.