MEDICARE: MS. KATHLEEN M CABIEDES 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	163WC0400X	Case Management Registered Nurse	696728	CA

General Provider Information

NPI Number	:	1750782587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN M CABIEDES RN

Provider Business Mailing Address
First Line	:	19318 JAEGER FARMS RD
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63038-1181
Country	:	US
Telephone Number	:	210-667-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	19318 JAEGER FARMS RD
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63038-1181
Country	:	US
Telephone Number	:	210-667-0399
Fax Number	:

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

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	09/11/2014

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