Provider Demographics
NPI:1780916999
Name:ZACHARA, KATHLEEN A (LPN,RCS)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:A
Last Name:ZACHARA
Suffix:
Gender:F
Credentials:LPN,RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6992 E ROCK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK CITY
Mailing Address - State:IL
Mailing Address - Zip Code:61070-9522
Mailing Address - Country:US
Mailing Address - Phone:815-865-5925
Mailing Address - Fax:
Practice Address - Street 1:6992 E ROCK GROVE RD
Practice Address - Street 2:
Practice Address - City:ROCK CITY
Practice Address - State:IL
Practice Address - Zip Code:61070-9522
Practice Address - Country:US
Practice Address - Phone:815-865-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI307654-031164W00000X
IL043-026812164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse