Provider Demographics
NPI:1902875115
Name:KOSTROSKI, KATHLEEN M (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:KOSTROSKI
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 1:1120 PRAIRIE DRIVE 36
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5617
Mailing Address - Country:US
Mailing Address - Phone:262-886-1582
Mailing Address - Fax:
Practice Address - Street 1:1120 PRAIRIE DR
Practice Address - Street 2:36
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5617
Practice Address - Country:US
Practice Address - Phone:262-886-1582
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94753030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse