Provider Demographics
NPI:1619123098
Name:BOHNE, KATHLEEN M (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:BOHNE
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 1:803 VIVIAN CT
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6100
Mailing Address - Country:US
Mailing Address - Phone:701-400-6190
Mailing Address - Fax:
Practice Address - Street 1:1701 PHILLIPS CIR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6717
Practice Address - Country:US
Practice Address - Phone:307-685-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY23390163W00000X
NDR21677163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse