Provider Demographics
NPI:1013095181
Name:KLINE, EDITH EDIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:EDIE
Last Name:KLINE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:WINDOW ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86515-0685
Mailing Address - Country:US
Mailing Address - Phone:928-729-8469
Mailing Address - Fax:928-729-8498
Practice Address - Street 1:CORNER OF ROUTES N12 & N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86501-0649
Practice Address - Country:US
Practice Address - Phone:928-729-8469
Practice Address - Fax:928-729-8498
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN081623163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse