Provider Demographics
NPI:1689223620
Name:WARREN, KATHY JANE
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JANE
Last Name:WARREN
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 1:1277 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:IN
Mailing Address - Zip Code:47610-9692
Mailing Address - Country:US
Mailing Address - Phone:812-588-2277
Mailing Address - Fax:
Practice Address - Street 1:1277 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:IN
Practice Address - Zip Code:47610-9692
Practice Address - Country:US
Practice Address - Phone:812-588-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider