Provider Demographics
NPI:1326678772
Name:PAONE-KOPALA, KATHRYN ANN (CNA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:PAONE-KOPALA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:PAONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:1430 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1236
Mailing Address - Country:US
Mailing Address - Phone:773-505-0567
Mailing Address - Fax:
Practice Address - Street 1:1430 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1236
Practice Address - Country:US
Practice Address - Phone:773-505-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care