Provider Demographics
NPI:1780980094
Name:MEADOWS, KATHLEEN ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:MEADOWS
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:BOX 95
Mailing Address - Street 2:3 SOUTH STREET
Mailing Address - City:MARATHON
Mailing Address - State:NY
Mailing Address - Zip Code:13803
Mailing Address - Country:US
Mailing Address - Phone:607-849-3508
Mailing Address - Fax:
Practice Address - Street 1:3 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:NY
Practice Address - Zip Code:13803
Practice Address - Country:US
Practice Address - Phone:607-849-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse