MEDICARE: MS. KATHLEEN ANN ULRICH LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN057875L	PA

General Provider Information

NPI Number	:	1144551565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANN ULRICH LPN

Provider Business Mailing Address
First Line	:	796 LOCUST RIDGE DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15209-2045
Country	:	US
Telephone Number	:	412-715-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3288 BABCOCK BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-2839
Country	:	US
Telephone Number	:	412-367-3620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	01/25/2010

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