Provider Demographics
NPI:1700121126
Name:MERTZ, KATHY LUAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LUAN
Last Name:MERTZ
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 1:10465 MILLCREEK RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8813
Mailing Address - Country:US
Mailing Address - Phone:937-441-8162
Mailing Address - Fax:
Practice Address - Street 1:10465 MILLCREEK RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8813
Practice Address - Country:US
Practice Address - Phone:937-441-8162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-077229164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse