Provider Demographics
NPI:1477391753
Name:ADDIE, KATRINA RENITA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:RENITA
Last Name:ADDIE
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 1:145 GARDEN DR APT 301
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-4496
Mailing Address - Country:US
Mailing Address - Phone:229-406-1274
Mailing Address - Fax:
Practice Address - Street 1:145 GARDEN DR APT 301
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-4496
Practice Address - Country:US
Practice Address - Phone:229-406-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant