MEDICARE: MS. KATHRYN S PAINE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	RN149780	AZ

General Provider Information

NPI Number	:	1063730703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN S PAINE RN

Provider Business Mailing Address
First Line	:	2149 EAST CARVER DRIVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040
Country	:	US
Telephone Number	:	602-232-4950
Fax Number	:	602-305-4696

Provider Business Practice Location Address
First Line	:	2149 E CARVER DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2533
Country	:	US
Telephone Number	:	602-232-4950
Fax Number	:	602-305-4696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	05/05/2010

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