Provider Demographics
NPI:1083691760
Name:BIRDSELL, KATHERINE E (RN NP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:E
Last Name:BIRDSELL
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:PRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN NP
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-3345
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3345
Practice Address - Fax:216-844-5431
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.024480363L00000X
TN109076363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440450Medicaid