Provider Demographics
NPI:1346042892
Name:ETTANDIP, KATHY A
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:ETTANDIP
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BIRCH HILL DR APT B13
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1451
Mailing Address - Country:US
Mailing Address - Phone:330-631-1534
Mailing Address - Fax:330-631-1534
Practice Address - Street 1:520 BIRCH HILL DR APT B13
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1451
Practice Address - Country:US
Practice Address - Phone:424-303-2579
Practice Address - Fax:424-303-2579
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker