Provider Demographics
NPI:1366731895
Name:MOTUSH, KATHLEEN G (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:G
Last Name:MOTUSH
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 1:19680 S 188TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7067
Mailing Address - Country:US
Mailing Address - Phone:480-279-7815
Mailing Address - Fax:480-279-7805
Practice Address - Street 1:19680 S 188TH ST
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7067
Practice Address - Country:US
Practice Address - Phone:480-279-7815
Practice Address - Fax:480-279-7805
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN152033163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool