Provider Demographics
NPI:1467793414
Name:KOERTEN, KATHRYN M (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:M
Last Name:KOERTEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W226N2610 ASPENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-8828
Mailing Address - Country:US
Mailing Address - Phone:262-751-3889
Mailing Address - Fax:
Practice Address - Street 1:W226N2610 ASPENWOOD LN
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-8828
Practice Address - Country:US
Practice Address - Phone:262-751-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI194540-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse