Provider Demographics
NPI:1265528756
Name:BENDER, KATHLEEN ROSEMARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ROSEMARIE
Last Name:BENDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:ROSEMARIE
Other - Last Name:DEMARAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:24575 HALLEY CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1616
Mailing Address - Country:US
Mailing Address - Phone:734-676-2794
Mailing Address - Fax:
Practice Address - Street 1:33101 ANNAPOLIS ST STE B
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2405
Practice Address - Country:US
Practice Address - Phone:734-721-0200
Practice Address - Fax:734-721-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704110454163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent