Provider Demographics
NPI:1386284081
Name:VAN BEEK, KATIE FRANCIS (BSN, RN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:FRANCIS
Last Name:VAN BEEK
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 WHIPPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1160
Mailing Address - Country:US
Mailing Address - Phone:920-209-7131
Mailing Address - Fax:
Practice Address - Street 1:1364 WHIPPLETREE LN
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1160
Practice Address - Country:US
Practice Address - Phone:920-209-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI218512-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse