Provider Demographics
NPI:1851622344
Name:KATAHDIN, KATHERINE HAZLE SHEPPARD
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:HAZLE SHEPPARD
Last Name:KATAHDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:HAZLE
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1824 RUSTICA DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1319
Mailing Address - Country:US
Mailing Address - Phone:919-598-9619
Mailing Address - Fax:
Practice Address - Street 1:1824 RUSTICA DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1319
Practice Address - Country:US
Practice Address - Phone:919-598-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula