Provider Demographics
NPI:1720328032
Name:INTERRANTE, KATHY DIANE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:DIANE
Last Name:INTERRANTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 STARFIRE DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1737
Mailing Address - Country:US
Mailing Address - Phone:614-563-6723
Mailing Address - Fax:
Practice Address - Street 1:6956 STARFIRE DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1737
Practice Address - Country:US
Practice Address - Phone:614-563-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 152131-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse