Provider Demographics
NPI:1043198823
Name:ELLSWORTH, KATHLEEN N (LPN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:N
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-0355
Mailing Address - Country:US
Mailing Address - Phone:413-346-8804
Mailing Address - Fax:413-346-8804
Practice Address - Street 1:PO BOX 355
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-0355
Practice Address - Country:US
Practice Address - Phone:413-346-8804
Practice Address - Fax:413-346-8804
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN87599164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse