Provider Demographics
NPI:1144405978
Name:DREW, KATHRYN ROSE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ROSE
Last Name:DREW
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 1:1542 STANHOPE KELLOGGSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-8473
Mailing Address - Country:US
Mailing Address - Phone:440-577-1943
Mailing Address - Fax:
Practice Address - Street 1:1542 STANHOPE KELLOGGSVILLE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-8473
Practice Address - Country:US
Practice Address - Phone:440-577-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN . 103489164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2229270Medicaid