Healthcare Provider Details

I. General information

NPI: 1033535174
Provider Name (Legal Business Name): PATRICIA MARIAN KURATEK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51600 HUNTINGTON RD
LA PINE OR
97739-8887
US

IV. Provider business mailing address

PO BOX 4879
SUNRIVER OR
97707-1879
US

V. Phone/Fax

Practice location:
  • Phone: 541-536-3435
  • Fax:
Mailing address:
  • Phone: 541-390-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number200842217RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200842217RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number200842217RN
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number200842217RN
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number200842217RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: