Provider Demographics
NPI:1457097362
Name:KATH, RAEGAN
Entity Type:Individual
Prefix:
First Name:RAEGAN
Middle Name:
Last Name:KATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 PRESCOTT LN
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8120
Mailing Address - Country:US
Mailing Address - Phone:701-371-0108
Mailing Address - Fax:
Practice Address - Street 1:9470 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:HANKINSON
Practice Address - State:ND
Practice Address - Zip Code:58041-9744
Practice Address - Country:US
Practice Address - Phone:701-371-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant