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NPI Code Detail

MEDICARE: KATHLEEN MARY MORAN KRETSCHMANN RN

MEDICARE: KATHLEEN MARY MORAN KRETSCHMANN 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
1163W00000XRegistered NurseRN104138GA

General Provider Information

NPI Number : 1821003559
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN MARY MORAN KRETSCHMANN RN
Provider Business Mailing Address
First Line : 808 LANGDON LN
Second Line :
City : PEACHTREE CITY
State : GA
Zip : 30269-1253
Country : US
Telephone Number : 770-631-1893
Fax Number :
Provider Business Practice Location Address
First Line : 1636 CONNALLY DR
Second Line :
City : EAST POINT
State : GA
Zip : 30344-2558
Country : US
Telephone Number : 404-762-4042
Fax Number : 404-762-3114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2006
Last Update Date : 07/08/2007

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