Provider Demographics
NPI:1316434293
Name:RATHJEN, KATRINA LORRAYNE (DO)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LORRAYNE
Last Name:RATHJEN
Suffix:
Gender:F
Credentials:DO
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:821 N NELLIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5387
Practice Address - Country:US
Practice Address - Phone:702-438-4003
Practice Address - Fax:702-438-0555
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10064713207R00000X
NVDO3240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO3240OtherSTATE LICENSE
NV1316434293Medicaid