1114938305 NPI number — MRS. KATHLEEN ANN MONTEY LPN RCS

Table of content: MRS. KATHLEEN ANN MONTEY LPN RCS (NPI 1114938305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114938305 NPI number — MRS. KATHLEEN ANN MONTEY LPN RCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTEY
Provider First Name:
KATHLEEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN RCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDREW
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114938305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-872-2451
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 WHITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-583-4420
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2006

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: 164W00000X , with the licence number:  7510031 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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