Provider Demographics
NPI:1609353481
Name:VACHALEK, KATHERINE LYNN
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNN
Last Name:VACHALEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LYNN
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:41680 MISS BESSIE DR
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2906
Mailing Address - Country:US
Mailing Address - Phone:301-997-0055
Mailing Address - Fax:
Practice Address - Street 1:41680 MISS BESSIE DR
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2906
Practice Address - Country:US
Practice Address - Phone:301-997-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily