Basic Information
| Provider Information | |||||||||
| NPI: | 1962433623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | URLAUB | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PAC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | URLAUB | ||||||||
| OtherFirstName: | CATHY | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 BROADWAY N | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581023641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012342000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PAC0307 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 854663100 | 05 | ND | MEDICAID | 0118330 | 01 | ND | MEDICA # | OTHER | 137122 | 01 | ND | UCARE # | OTHER | 845S8UR | 01 | ND | MNBS # | OTHER | 0118329 | 01 | ND | MEDICA # | OTHER | 2155910 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | 24645 | 01 | ND | NDBS # | OTHER | DA9011041360 | 01 | ND | PREFERRED ONE # | OTHER | HP43172 | 01 | ND | HEALHTPARTNERS # | OTHER |