Provider Demographics
NPI:1598885691
Name:IWANOWSKI, KATHLEEN M (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:IWANOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:IWANOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:15520 SONOMA DR APT 103
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15520 SONOMA DR APT 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7311
Practice Address - Country:US
Practice Address - Phone:239-220-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2498332163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health