Provider Demographics
NPI:1184805475
Name:EPPICH, KATHLEEN L (LPN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:L
Last Name:EPPICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 W THOMPSON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3208
Mailing Address - Country:US
Mailing Address - Phone:623-523-8440
Mailing Address - Fax:623-523-8411
Practice Address - Street 1:11800 W THOMPSON RANCH RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-3208
Practice Address - Country:US
Practice Address - Phone:623-523-8440
Practice Address - Fax:623-523-8411
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP041753164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse