Provider Demographics
NPI:1063730703
Name:PAINE, KATHRYN S (RN)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:S
Last Name:PAINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 EAST CARVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040
Mailing Address - Country:US
Mailing Address - Phone:602-232-4950
Mailing Address - Fax:602-305-4696
Practice Address - Street 1:2149 E CARVER DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-2533
Practice Address - Country:US
Practice Address - Phone:602-232-4950
Practice Address - Fax:602-305-4696
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN149780163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool