Provider Demographics
NPI:1851819114
Name:KUDLICH, MAUREEN (LPN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:KUDLICH
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 1:3924 ROSSBERG ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3592
Mailing Address - Country:US
Mailing Address - Phone:360-481-6461
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE ATTN:MCHJ-CLQ-C ATTN PATRICIA SHUSTER
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPN60603853164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse