Basic Information
Provider Information
NPI: 1700212065
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEENBRUGGEN
FirstName: KATHLEEN
MiddleName: M
NamePrefix: MRS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 72 JAQUES AVE
Address2:  
City: WORCESTER
State: MA
PostalCode: 016102476
CountryCode: US
TelephoneNumber: 5088601260
FaxNumber: 5088601068
Practice Location
Address1: 72 JAQUES AVE
Address2:  
City: WORCESTER
State: MA
PostalCode: 016102476
CountryCode: US
TelephoneNumber: 5088601260
FaxNumber: 5088601068
Other Information
ProviderEnumerationDate: 09/18/2013
LastUpdateDate: 09/18/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WC1500XRN17955MAY Nursing Service ProvidersRegistered NurseCommunity Health

No ID Information.


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