Provider Demographics
NPI:1609603521
Name:WEATHERFORD, KATRINA CHLOE
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:CHLOE
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11854 COUNTY ROAD T
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-9096
Mailing Address - Country:US
Mailing Address - Phone:715-897-5207
Mailing Address - Fax:
Practice Address - Street 1:11854 COUNTY ROAD T
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-9096
Practice Address - Country:US
Practice Address - Phone:715-897-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0017192376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator