1407123219 NPI number — MRS. KATHLEEN ANN FUGLEE RN, MN, CNS, CDE

Table of content: MRS. KATHLEEN ANN FUGLEE RN, MN, CNS, CDE (NPI 1407123219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407123219 NPI number — MRS. KATHLEEN ANN FUGLEE RN, MN, CNS, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUGLEE
Provider First Name:
KATHLEEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MN, CNS, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAEPPLINGER/TOWNSEND
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407123219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3710 SW US VETERANS HOSPITAL ROAD
Provider Second Line Business Mailing Address:
PO BOX 1034
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97207-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-220-8262
Provider Business Mailing Address Fax Number:
503-721-7903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3710 SW US VETERANS HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
PRIMARY CARE ROOM F 120
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97207-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-220-8262
Provider Business Practice Location Address Fax Number:
503-721-7903
Provider Enumeration Date:
11/22/2011

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: 364S00000X , with the licence number:  200270007CNS , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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