Provider Demographics
NPI:1407123219
Name:FUGLEE, KATHLEEN ANN (RN, MN, CNS, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:FUGLEE
Suffix:
Gender:F
Credentials:RN, MN, CNS, CDE
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:KAEPPLINGER/TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3710 SW US VETERANS HOSPITAL ROAD
Mailing Address - Street 2:PO BOX 1034
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-1034
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-721-7903
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL ROAD
Practice Address - Street 2:PRIMARY CARE ROOM F 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97207-1034
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:503-721-7903
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200270007CNS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist