Provider Demographics
NPI:1992516223
Name:DENNIS, KAITLYNN RUTH (RN)
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:RUTH
Last Name:DENNIS
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 1:415 E GEORGE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1230
Mailing Address - Country:US
Mailing Address - Phone:563-200-1102
Mailing Address - Fax:
Practice Address - Street 1:415 E GEORGE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-1230
Practice Address - Country:US
Practice Address - Phone:563-200-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA177342163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse