Provider Demographics
NPI:1942505300
Name:MORTIER, KATIE LYNN (KATIE MORTIER)
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:LYNN
Last Name:MORTIER
Suffix:
Gender:F
Credentials:KATIE MORTIER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10421 W DARNEL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2648
Mailing Address - Country:US
Mailing Address - Phone:920-277-6146
Mailing Address - Fax:
Practice Address - Street 1:10421 W DARNEL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2648
Practice Address - Country:US
Practice Address - Phone:920-277-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149864-030163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics