Provider Demographics
NPI:1801370655
Name:EKLUND, KATHLEEN MAIRIN (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MAIRIN
Last Name:EKLUND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MAIRIN
Other - Last Name:BOODEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KATHLEEN EVANS
Mailing Address - Street 1:CENTER FOR ADVANCED PRACTICE DUMC 3458
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010996363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics