Provider Demographics
NPI:1124792361
Name:MATAY, KATHLEEN GAEL (RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GAEL
Last Name:MATAY
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 1:12565 RENAISSANCE CIR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-5898
Mailing Address - Country:US
Mailing Address - Phone:708-590-5112
Mailing Address - Fax:708-590-5074
Practice Address - Street 1:12565 RENAISSANCE CIR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-5898
Practice Address - Country:US
Practice Address - Phone:708-590-5112
Practice Address - Fax:708-590-5074
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041235961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse