Provider Demographics
NPI:1417003716
Name:RICHARDSON, KATHIE DENISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHIE
Middle Name:DENISE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KATHIE
Other - Middle Name:DENISE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:S75W31046 FLORENCE CT
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9215
Mailing Address - Country:US
Mailing Address - Phone:262-363-3043
Mailing Address - Fax:
Practice Address - Street 1:S75W31046 FLORENCE CT
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9215
Practice Address - Country:US
Practice Address - Phone:262-363-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI108060163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39855100Medicaid