Healthcare Provider Details

I. General information

NPI: 1861483273
Provider Name (Legal Business Name): KATHLEEN J WILTSIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 OAKINGTON ST KIRK US ARMY HEALTH CLINIC
ABERDEEN PROVING GROUND MD
21005-5131
US

IV. Provider business mailing address

2501 OAKINGTON ST KIRK US ARMY HEALTH CLINIC
ABERDEEN PROVING GROUND MD
21005-5131
US

V. Phone/Fax

Practice location:
  • Phone: 410-278-1961
  • Fax: 410-278-7330
Mailing address:
  • Phone: 410-278-1961
  • Fax: 410-278-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number71929-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: