Provider Demographics
NPI:1467049098
Name:VANHORN, KATHIE
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:
Last Name:VANHORN
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 1:8777 COUNTY HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:OH
Mailing Address - Zip Code:43359-9788
Mailing Address - Country:US
Mailing Address - Phone:419-310-9675
Mailing Address - Fax:
Practice Address - Street 1:8777 COUNTY HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:OH
Practice Address - Zip Code:43359-9788
Practice Address - Country:US
Practice Address - Phone:419-310-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH88005243747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0183708Medicaid
OH104392013999Medicaid