Provider Demographics
NPI:1063983609
Name:D'ANCONA, KATHRYN (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:D'ANCONA
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 1:6408 KALGAN RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-3522
Mailing Address - Country:US
Mailing Address - Phone:610-585-5209
Mailing Address - Fax:
Practice Address - Street 1:301 ALAME LOOP
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-6034
Practice Address - Country:US
Practice Address - Phone:505-966-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-86999163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRN-86999OtherRN LICENSE