Provider Demographics
NPI:1295290955
Name:KOTTWITZ, KIM KATHLEEN (RN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:KATHLEEN
Last Name:KOTTWITZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2736
Mailing Address - Country:US
Mailing Address - Phone:716-701-6813
Mailing Address - Fax:701-701-6854
Practice Address - Street 1:135 N UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2736
Practice Address - Country:US
Practice Address - Phone:716-701-6813
Practice Address - Fax:701-701-6854
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse