Provider Demographics
NPI:1891709887
Name:PFAHL, KATHLEEN MARY (APRN BC CS)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:PFAHL
Suffix:
Gender:F
Credentials:APRN BC CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 270TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1603
Mailing Address - Country:US
Mailing Address - Phone:216-798-5848
Mailing Address - Fax:216-383-3750
Practice Address - Street 1:300 E 185TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-1330
Practice Address - Country:US
Practice Address - Phone:216-383-2222
Practice Address - Fax:216-383-3750
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN12250163WW0000X
OHRN122250163WX1500X
OHNS-06874364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WW0000XNursing Service ProvidersRegistered NurseWound Care
Not Answered163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
Not Answered364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN 122250OtherSTATE BOARD OF NURSING
OHIN PROCESSMedicaid
OHRX 06874OtherSTATE BOARD OF NURSING
OHRN 122250OtherSTATE BOARD OF NURSING
Q13092Medicare UPIN