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General NPI Number Information
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NPI Number | 1043573686
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Entity Type | Individual
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Provider Name | MARY KATHERINE KLEPADLO APRN
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Gender | Female
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 3338 FARNSWORTH ST
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City | DETROIT
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State | MI
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Zip | 48211-3024
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Country | US
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Telephone | 313-924-9123
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Fax |
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Provider Business Mailing Address
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Address Line | 3338 FARNSWORTH ST
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City | DETROIT
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State | MI
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Zip | 48211-3024
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Country | US
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Telephone | 313-924-9123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704185649
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 4704185649
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 4704185649
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704185649
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 4704185649
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License Number State | MI
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