Basic Information
| Provider Information | |||||||||
| NPI: | 1013095181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLINE | ||||||||
| FirstName: | EDITH | ||||||||
| MiddleName: | EDIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | REGISTERED NURSE | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 685 | ||||||||
| Address2: | |||||||||
| City: | WINDOW ROCK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865150685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287298469 | ||||||||
| FaxNumber: | 9287298498 | ||||||||
| Practice Location | |||||||||
| Address1: | CORNER OF ROUTES N12 & N7 | ||||||||
| Address2: | |||||||||
| City: | FORT DEFIANCE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865010649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287298469 | ||||||||
| FaxNumber: | 9287298498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN081623 | AZ | Y | Nursing Service Providers | Registered Nurse |
No ID Information.