Provider Demographics
NPI:1578999751
Name:LANHAM, KATRINA R (RN)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:R
Last Name:LANHAM
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 1:110 MORDINGTON AVE
Mailing Address - Street 2:JEFFERSON COUNTY BOARD OF EDUCATION
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-1693
Mailing Address - Country:US
Mailing Address - Phone:304-267-3595
Mailing Address - Fax:130-426-7359
Practice Address - Street 1:110 MORDINGTON AVE
Practice Address - Street 2:JEFFERSON COUNTY BOARD OF EDUCATION
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1693
Practice Address - Country:US
Practice Address - Phone:304-267-3595
Practice Address - Fax:130-426-7359
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV64879163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse