1295796373 NPI number — KATHLEEN E KLAS P.N.P., R.N.F.A.

Table of content: KATHLEEN E KLAS P.N.P., R.N.F.A. (NPI 1295796373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295796373 NPI number — KATHLEEN E KLAS P.N.P., R.N.F.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLAS
Provider First Name:
KATHLEEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.N.P., R.N.F.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZERN
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295796373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 E THOMAS RD
Provider Second Line Business Mailing Address:
BUILDING 2108, SUITE 101
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-7710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-512-8029
Provider Business Mailing Address Fax Number:
602-512-8161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 E THOMAS RD
Provider Second Line Business Practice Location Address:
AMBULATORY BUILDING
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-7710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-933-0975
Provider Business Practice Location Address Fax Number:
602-933-0445
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  RN103690/AP1529 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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