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General NPI Number Information
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NPI Number | 1417254764
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Entity Type | Individual
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Provider Name | KATHRYN ANN KHANDAKER M.S.N., R.N., C.N.P.
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Gender | Female
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 725 S SHOOP AVE STE G-03
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City | WAUSEON
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State | OH
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Zip | 43567-1702
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Country | US
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Telephone | 419-337-7832
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Fax | 419-337-7833
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Provider Business Mailing Address
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Address Line | 725 S SHOOP AVE STE G-03
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City | WAUSEON
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State | OH
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Zip | 43567-1702
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Country | US
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Telephone | 419-337-7832
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Fax | 419-337-7833
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | COA.12210-NP
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License Number State | OH
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