Healthcare Provider Details

I. General information

NPI: 1992033427
Provider Name (Legal Business Name): KATHLEEN HELEN AUSTIN NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 8TH ST
IMPERIAL BEACH CA
91932
US

IV. Provider business mailing address

785 8TH ST
IMPERIAL BEACH CA
91932-2111
US

V. Phone/Fax

Practice location:
  • Phone: 916-424-6531
  • Fax:
Mailing address:
  • Phone: 619-424-6531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number436716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: