Provider Demographics
NPI:1356591796
Name:ELLIOTT, KATHRYN S I (RN,BSN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:ELLIOTT
Suffix:I
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 TOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2407
Mailing Address - Country:US
Mailing Address - Phone:330-392-0311
Mailing Address - Fax:330-392-2158
Practice Address - Street 1:1460 TOD AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2407
Practice Address - Country:US
Practice Address - Phone:330-392-0311
Practice Address - Fax:330-392-2158
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN129698163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care