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General NPI Number Information
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NPI Number | 1871018564
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Entity Type | Individual
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Provider Name | CORY KATSMA RN
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Gender | Male
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7395 FREDERICK PL
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City | WEST BEND
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State | WI
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Zip | 53090-8643
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Country | US
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Telephone | 262-339-8093
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Fax |
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Provider Business Mailing Address
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Address Line | 7395 FREDERICK PL
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City | WEST BEND
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State | WI
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Zip | 53090-8643
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Country | US
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Telephone | 262-339-8093
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 321915-31
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 243446-30
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License Number State | WI
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