Provider Demographics
NPI:1477227585
Name:MCHUGH, KATHERN MELISSA (RN)
Entity Type:Individual
Prefix:
First Name:KATHERN
Middle Name:MELISSA
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:112 VISTA DEL PARCO RD
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53178-9688
Mailing Address - Country:US
Mailing Address - Phone:262-582-3171
Mailing Address - Fax:
Practice Address - Street 1:112 VISTA DEL PARCO RD
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:WI
Practice Address - Zip Code:53178-9688
Practice Address - Country:US
Practice Address - Phone:262-582-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI116969-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health