Provider Demographics
NPI:1457827834
Name:ROSTYNE, KATLYN ELIZABETH
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:ELIZABETH
Last Name:ROSTYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PUGH ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:SD
Mailing Address - Zip Code:57551-7700
Mailing Address - Country:US
Mailing Address - Phone:605-685-6868
Mailing Address - Fax:
Practice Address - Street 1:302 S DUMONT AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:SD
Practice Address - Zip Code:57385
Practice Address - Country:US
Practice Address - Phone:605-796-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR040573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily