Provider Demographics
NPI:1053957373
Name:MEMBER, KATHERINE A (RN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:MEMBER
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 1:514 LAFAYETTE RD STE D
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3494
Mailing Address - Country:US
Mailing Address - Phone:973-940-2400
Mailing Address - Fax:
Practice Address - Street 1:514 LAFAYETTE RD STE D
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3494
Practice Address - Country:US
Practice Address - Phone:973-940-2400
Practice Address - Fax:973-940-0138
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN3422579L163WA2000X
NJ26NO10700800163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator