MEDICARE: KATHY L FIELD L.P.N.

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	4703051742	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4703051742	OTHER	MI	LPN LICENSE

General Provider Information

NPI Number	:	1568670552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY L FIELD L.P.N.

Provider Business Mailing Address
First Line	:	8085 DIXON RD
Second Line	:
City	:	RIVES JUNCTION
State	:	MI
Zip	:	49277-9685
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1949 LANSING AVE
Second Line	:	SUITE 'B'
City	:	JACKSON
State	:	MI
Zip	:	49202-2190
Country	:	US
Telephone Number	:	517-784-2929
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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