Basic Information
Provider Information
NPI: 1467189530
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRYCH
FirstName: KARI
MiddleName: JO
NamePrefix: MS.
NameSuffix:  
Credential: APRN, CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 400 E 3RD ST
Address2:  
City: DULUTH
State: MN
PostalCode: 558051951
CountryCode: US
TelephoneNumber: 2187868364
FaxNumber:  
Practice Location
Address1: 407 E 3RD ST
Address2:  
City: DULUTH
State: MN
PostalCode: 558051950
CountryCode: US
TelephoneNumber: 2187864000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/08/2022
LastUpdateDate: 08/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X1558506MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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