Provider Demographics
NPI:1902319098
Name:CLINE, KATHY (RN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CLINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15083 NW EUGENE LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-0921
Mailing Address - Country:US
Mailing Address - Phone:714-423-6487
Mailing Address - Fax:
Practice Address - Street 1:113 SONORA AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3833
Practice Address - Country:US
Practice Address - Phone:714-423-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201110163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant