Provider Demographics
NPI:1366077679
Name:REYNOLDS-OEZER, KATIE LAURA (LPN)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LAURA
Last Name:REYNOLDS-OEZER
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 1:164 S ASH LN
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-2188
Mailing Address - Country:US
Mailing Address - Phone:920-285-4920
Mailing Address - Fax:
Practice Address - Street 1:164 S ASH LN
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-2188
Practice Address - Country:US
Practice Address - Phone:920-285-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI304885-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty