Provider Demographics
NPI:1619212743
Name:IMMEL, KATIE J
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:IMMEL
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 1:225 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1209
Mailing Address - Country:US
Mailing Address - Phone:330-749-7920
Mailing Address - Fax:
Practice Address - Street 1:225 HOWARD ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1209
Practice Address - Country:US
Practice Address - Phone:330-749-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula