Provider Demographics
NPI:1780431866
Name:MCENTYRE, KATIE NYCOLE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:NYCOLE
Last Name:MCENTYRE
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 1:3106 ARCHWOOD AVE APT 211
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-6300
Mailing Address - Country:US
Mailing Address - Phone:352-286-3795
Mailing Address - Fax:
Practice Address - Street 1:3106 ARCHWOOD AVE APT 211
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-6300
Practice Address - Country:US
Practice Address - Phone:352-286-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider