Provider Demographics
NPI:1689064073
Name:ROHDE-KILLORAN, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:ROHDE-KILLORAN
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:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-0755
Mailing Address - Country:US
Mailing Address - Phone:253-884-1517
Mailing Address - Fax:
Practice Address - Street 1:17512-24TH ST.KP
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349
Practice Address - Country:US
Practice Address - Phone:253-884-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALPNLP00018565164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse