Provider Demographics
NPI:1093277873
Name:VOLLMAN, KATHLEEN MARY (MSN, RN, CCNS, FAAN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:VOLLMAN
Suffix:
Gender:F
Credentials:MSN, RN, CCNS, FAAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20192 BOULDER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2732
Mailing Address - Country:US
Mailing Address - Phone:313-570-1450
Mailing Address - Fax:
Practice Address - Street 1:21091 BOULDER CIR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167
Practice Address - Country:US
Practice Address - Phone:313-570-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704132359251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care