Provider Demographics
NPI:1861509366
Name:MITTEN, KATHLEEN (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:MITTEN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:KOZLOVSKY
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:#245
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:877-576-3544
Practice Address - Fax:414-649-3763
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56367-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse