Provider Demographics
NPI:1508369026
Name:MAINELLA, KATHY ANN I (LPN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:MAINELLA
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 FARLEY LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1526
Mailing Address - Country:US
Mailing Address - Phone:218-724-0343
Mailing Address - Fax:
Practice Address - Street 1:167 FARLEY LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-1526
Practice Address - Country:US
Practice Address - Phone:218-724-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-11
Last Update Date:2018-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN234054164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse