Provider Demographics
NPI:1407476559
Name:VARDEMAN, KATHERINE (RN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:VARDEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:OESTERLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3243 93RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-3747
Mailing Address - Country:US
Mailing Address - Phone:319-427-1381
Mailing Address - Fax:
Practice Address - Street 1:3243 93RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-3747
Practice Address - Country:US
Practice Address - Phone:319-427-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX811168163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse