Provider Demographics
NPI:1033241229
Name:CROSSEN, KATHERINE MARY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARY
Last Name:CROSSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 COUNTY ROAD 1975
Mailing Address - Street 2:
Mailing Address - City:JEROMESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44840-9787
Mailing Address - Country:US
Mailing Address - Phone:419-368-8385
Mailing Address - Fax:
Practice Address - Street 1:337 COUNTY ROAD 1975
Practice Address - Street 2:
Practice Address - City:JEROMESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44840-9787
Practice Address - Country:US
Practice Address - Phone:419-368-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH067131164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2455249Medicare ID - Type UnspecifiedPROVIDER