Provider Demographics
NPI:1427077387
Name:JANUARY, KATHY ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:JANUARY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2364 DELAWARE AVE
Mailing Address - Street 2:APT A
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-2532
Mailing Address - Country:US
Mailing Address - Phone:847-508-1799
Mailing Address - Fax:
Practice Address - Street 1:2364 DELAWARE AVE
Practice Address - Street 2:APT A
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2532
Practice Address - Country:US
Practice Address - Phone:847-508-1799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-275899163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care