Provider Demographics
NPI:1609528702
Name:LONEY, KATRINA MARIE
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:LONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10357 NW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-2253
Mailing Address - Country:US
Mailing Address - Phone:515-867-3569
Mailing Address - Fax:
Practice Address - Street 1:10357 NW 42ND ST
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-2253
Practice Address - Country:US
Practice Address - Phone:515-867-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker