Provider Demographics
NPI:1740728674
Name:RAWLINGS, KATIE (LPN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:RAWLINGS
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 1:525 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAVE IN ROCK
Mailing Address - State:IL
Mailing Address - Zip Code:62919-2103
Mailing Address - Country:US
Mailing Address - Phone:618-715-5166
Mailing Address - Fax:
Practice Address - Street 1:72 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-3390
Practice Address - Country:US
Practice Address - Phone:618-294-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-11
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.076481164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse