MEDICARE: MS. KATHLEEN PATRICIA DENESHA RN

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	208D00000X	General Practice Physician	MB048583	NJ

General Provider Information

NPI Number	:	1235340316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN PATRICIA DENESHA RN

Provider Business Mailing Address
First Line	:	197 BLACKMAN RD
Second Line	:
City	:	EHT
State	:	NJ
Zip	:	08234-7514
Country	:	US
Telephone Number	:	609-788-8822
Fax Number	:	609-339-9157

Provider Business Practice Location Address
First Line	:	500 E 6TH ST
Second Line	:
City	:	OCEAN CITY
State	:	NJ
Zip	:	08226-3826
Country	:	US
Telephone Number	:	609-399-1862
Fax Number	:	609-339-9157

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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