Provider Demographics
NPI:1821471137
Name:KOVACH, KATHRYN (LPN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KOVACH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR ON THE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2545
Mailing Address - Country:US
Mailing Address - Phone:440-520-5925
Mailing Address - Fax:
Practice Address - Street 1:5609 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MENTOR ON THE LAKE
Practice Address - State:OH
Practice Address - Zip Code:44060-2545
Practice Address - Country:US
Practice Address - Phone:440-520-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN072829MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse