Provider Demographics
NPI:1790376903
Name:KLEM, KAITLIN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:KLEM
Suffix:
Gender:F
Credentials:RN, BSN
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 1566
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-0917
Mailing Address - Country:US
Mailing Address - Phone:503-369-2460
Mailing Address - Fax:
Practice Address - Street 1:139 N 21ST ST
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6217
Practice Address - Country:US
Practice Address - Phone:503-369-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies