Provider Demographics
NPI:1154858165
Name:PETERSON, KATHLEEN LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:PETERSON
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 1:227 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3303
Mailing Address - Country:US
Mailing Address - Phone:610-376-6077
Mailing Address - Fax:610-376-6944
Practice Address - Street 1:227 N 5TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3303
Practice Address - Country:US
Practice Address - Phone:610-376-6077
Practice Address - Fax:610-376-6944
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN268416L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health