Provider Demographics
NPI:1629192828
Name:NORRIS, KATHRINE (AA)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:KATHRINE
Other - Middle Name:
Other - Last Name:SABO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 MONTEBELLO RD STE 202
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1366
Mailing Address - Country:US
Mailing Address - Phone:719-545-2746
Mailing Address - Fax:719-542-9638
Practice Address - Street 1:1302 CHINOOK LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-545-2746
Practice Address - Fax:719-542-9638
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37364164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse