Provider Demographics
NPI:1093467375
Name:UTERMARK, KATARINA I (CNA)
Entity Type:Individual
Prefix:
First Name:KATARINA
Middle Name:I
Last Name:UTERMARK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BLUE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BOONES MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24065-1103
Mailing Address - Country:US
Mailing Address - Phone:540-808-6808
Mailing Address - Fax:
Practice Address - Street 1:75 BLUE HILLS DR
Practice Address - Street 2:
Practice Address - City:BOONES MILL
Practice Address - State:VA
Practice Address - Zip Code:24065-1103
Practice Address - Country:US
Practice Address - Phone:540-808-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401191551251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1401191551OtherCNA STATE REGISTRY