Provider Demographics
NPI:1104171941
Name:TREVOR, KATHRYN DEBRA (LPN)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:DEBRA
Last Name:TREVOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KITTY
Other - Middle Name:DEBRA
Other - Last Name:TREVOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1104 KIMBERLY RD
Mailing Address - Street 2:#104
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4164
Mailing Address - Country:US
Mailing Address - Phone:563-940-1196
Mailing Address - Fax:
Practice Address - Street 1:2979 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2784
Practice Address - Country:US
Practice Address - Phone:563-332-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP38324164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse