MEDICARE: MS. KATIE RUTH GARDIPEE 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	163W00000X	Registered Nurse	175824-30	WA

General Provider Information

NPI Number	:	1841568516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATIE RUTH GARDIPEE RN

Provider Business Mailing Address
First Line	:	3713 S RUTLAND AVE
Second Line	:
City	:	SAINT FRANCIS
State	:	WI
Zip	:	53235-4138
Country	:	US
Telephone Number	:	414-581-3443
Fax Number	:

Provider Business Practice Location Address
First Line	:	3713 S RUTLAND AVE
Second Line	:
City	:	SAINT FRANCIS
State	:	WI
Zip	:	53235-4138
Country	:	US
Telephone Number	:	414-581-3443
Fax Number	:

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

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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