Provider Demographics
NPI:1922741560
Name:WASHBURN-MUTSCHER, KAYLEE RAE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:RAE
Last Name:WASHBURN-MUTSCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4134
Mailing Address - Country:US
Mailing Address - Phone:170-133-0240
Mailing Address - Fax:
Practice Address - Street 1:714 S 21ST ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4134
Practice Address - Country:US
Practice Address - Phone:170-133-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant