Provider Demographics
NPI:1114115011
Name:HEY, KATHLEEN RUDELLA (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RUDELLA
Last Name:HEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HUMBLE RD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3135
Mailing Address - Country:US
Mailing Address - Phone:330-633-2690
Mailing Address - Fax:330-633-2690
Practice Address - Street 1:808 HUMBLE ROAD
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3135
Practice Address - Country:US
Practice Address - Phone:330-633-2690
Practice Address - Fax:330-633-2690
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146326163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse