Healthcare Provider Details

I. General information

NPI: 1477227585
Provider Name (Legal Business Name): KATHERN MELISSA MCHUGH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE JONES RN

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 VISTA DEL PARCO RD
SULLIVAN WI
53178-9688
US

IV. Provider business mailing address

112 VISTA DEL PARCO RD
SULLIVAN WI
53178-9688
US

V. Phone/Fax

Practice location:
  • Phone: 262-582-3171
  • Fax:
Mailing address:
  • Phone: 262-582-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number116969-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: