Provider Demographics
NPI:1568670552
Name:FIELD, KATHY L (LPN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:FIELD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8085 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:RIVES JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49277-9685
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1949 LANSING AVE
Practice Address - Street 2:SUITE 'B'
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2190
Practice Address - Country:US
Practice Address - Phone:517-784-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703051742164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703051742OtherLPN LICENSE