Provider Demographics
NPI:1306329933
Name:LANEY, KATHERINE MARIE (RN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:LANEY
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 1:921 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-9408
Mailing Address - Country:US
Mailing Address - Phone:218-428-4746
Mailing Address - Fax:
Practice Address - Street 1:60 ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-9453
Practice Address - Country:US
Practice Address - Phone:218-485-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR198436-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice