Provider Demographics
NPI:1548091333
Name:MANN, KAITLIN ROSE (RN)
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:ROSE
Last Name:MANN
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 1:889 117TH ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4916
Mailing Address - Country:US
Mailing Address - Phone:219-218-6255
Mailing Address - Fax:
Practice Address - Street 1:889 117TH ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4916
Practice Address - Country:US
Practice Address - Phone:219-218-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28258914C163W00000X
CA95332056163W00000X
IN28258914A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse