Provider Demographics
NPI:1033574108
Name:THOM, KATHLEEN ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:THOM
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 1:16757 W. COUNTY ROAD DD
Mailing Address - Street 2:
Mailing Address - City:BIRCHWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54817-9151
Mailing Address - Country:US
Mailing Address - Phone:715-296-0114
Mailing Address - Fax:
Practice Address - Street 1:702 N. FRONT STREET
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54871
Practice Address - Country:US
Practice Address - Phone:715-635-3539
Practice Address - Fax:715-635-3086
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI117115-30163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health