Provider Demographics
NPI:1346995966
Name:JASS, KATI LYNNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATI
Middle Name:LYNNE
Last Name:JASS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KATI
Other - Middle Name:LYNNE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1316 LAPHAM ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-5511
Mailing Address - Country:US
Mailing Address - Phone:608-921-0420
Mailing Address - Fax:
Practice Address - Street 1:1312 BARBERRY DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0589
Practice Address - Country:US
Practice Address - Phone:608-758-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235843-30163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1578234902Medicaid