Provider Demographics
NPI:1184189227
Name:MEHL, KATHLEEN ANN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:MEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 BAY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:MI
Mailing Address - Zip Code:48133-9304
Mailing Address - Country:US
Mailing Address - Phone:734-625-7973
Mailing Address - Fax:
Practice Address - Street 1:10100 BAY CREEK RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:MI
Practice Address - Zip Code:48133-9304
Practice Address - Country:US
Practice Address - Phone:734-625-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.078474.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse