Provider Demographics
NPI:1699156448
Name:RATHKE, KATHLEEN M (MSN, AGNP, RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:RATHKE
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Gender:F
Credentials:MSN, AGNP, RN
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Mailing Address - Street 1:720 ESKENAZI AVE
Mailing Address - Street 2:IUHP GERIATRICS/ OPTIMISTIC PROJECT, SUITE F2-600
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5189
Mailing Address - Country:US
Mailing Address - Phone:317-202-7979
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:IUHP GERIATRICS/ OPTIMISTIC PROJECT, SUITE F2-600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5189
Practice Address - Country:US
Practice Address - Phone:317-880-6574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2016-01-31
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Provider Licenses
StateLicense IDTaxonomies
IN28112112A363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology