Provider Demographics
NPI:1770709008
Name:KLINE, ADONNA RAE (LPN)
Entity type:Individual
Prefix:MISS
First Name:ADONNA
Middle Name:RAE
Last Name:KLINE
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 1:811 ROOSA GAP ROAD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721
Mailing Address - Country:US
Mailing Address - Phone:303-947-8027
Mailing Address - Fax:
Practice Address - Street 1:811 ROOSA GAP ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMINGBURG
Practice Address - State:NY
Practice Address - Zip Code:12721
Practice Address - Country:US
Practice Address - Phone:303-947-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273664164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02830519Medicaid