Provider Demographics
NPI:1477727220
Name:MARQUARDT, KATHY LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LYNN
Last Name:MARQUARDT
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 1:635 EAGLEWATCH DR
Mailing Address - Street 2:
Mailing Address - City:DE FOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-3045
Mailing Address - Country:US
Mailing Address - Phone:608-846-7383
Mailing Address - Fax:
Practice Address - Street 1:635 EAGLEWATCH DR
Practice Address - Street 2:
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-3045
Practice Address - Country:US
Practice Address - Phone:608-846-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI95164-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38323200Medicaid