Provider Demographics
NPI:1518109958
Name:RODRIGUEZ, KATHRINE (LPN)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
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 1:7 HILLSIDE AVE
Mailing Address - Street 2:APT. A
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1911
Mailing Address - Country:US
Mailing Address - Phone:845-297-0144
Mailing Address - Fax:
Practice Address - Street 1:7 HILLSIDE AVE
Practice Address - Street 2:APT. A
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1911
Practice Address - Country:US
Practice Address - Phone:845-297-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236609-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse