Provider Demographics
NPI:1881015378
Name:ENGSTROM, KATHRYN LOUISE
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LOUISE
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:LOUISE
Other - Last Name:KLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6901 SE LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97267
Mailing Address - Country:US
Mailing Address - Phone:503-317-5227
Mailing Address - Fax:
Practice Address - Street 1:6901 SE LAKE ROAD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97267
Practice Address - Country:US
Practice Address - Phone:503-317-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR093000300RN163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health