Provider Demographics
NPI:1285184622
Name:KAISHIAN, KATHLEEN A (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:KAISHIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9723 W NATIONAL AVE
Mailing Address - Street 2:APT 23
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2264
Mailing Address - Country:US
Mailing Address - Phone:414-315-2655
Mailing Address - Fax:
Practice Address - Street 1:9723 WEST NATIONAL AVE.
Practice Address - Street 2:APT. 23
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2264
Practice Address - Country:US
Practice Address - Phone:414-315-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93183-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse