Individual
KATHERINE MARIE HANTKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 726-8218
Mailing address
2117 HILLCREST DR, VENTURA, CA 93001-2411
(805) 746-0075
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
798964
CA
163W00000X
Registered Nurse
RN2329625
MA
367500000X
Certified Registered Nurse Anesthetist
95000995
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2329625
MA
Other
Enumeration date
10/10/2018
Last updated
01/29/2019
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