Provider Demographics
NPI:1073096442
Name:CAROTHERS, KATE J (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:J
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1949
Mailing Address - Country:US
Mailing Address - Phone:715-828-4115
Mailing Address - Fax:
Practice Address - Street 1:1321 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1949
Practice Address - Country:US
Practice Address - Phone:715-828-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIL-10668163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant