Provider Demographics
NPI:1508147919
Name:MOTTERN, KATHLEEN BETH (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BETH
Last Name:MOTTERN
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 1:14358 BEAKER CT
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2050
Mailing Address - Country:US
Mailing Address - Phone:443-285-3599
Mailing Address - Fax:
Practice Address - Street 1:14358 BEAKER CT
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-2050
Practice Address - Country:US
Practice Address - Phone:443-285-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC219145163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse