Provider Demographics
NPI:1578901062
Name:MYERHOLTZ, KATHERINE KAY (NP-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KAY
Last Name:MYERHOLTZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:KAY
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1912 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4736
Mailing Address - Country:US
Mailing Address - Phone:419-557-7189
Mailing Address - Fax:
Practice Address - Street 1:1912 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4736
Practice Address - Country:US
Practice Address - Phone:419-557-7189
Practice Address - Fax:419-557-7109
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14541-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily