Provider Demographics
NPI:1003189200
Name:WIENER, KATHARINE BETTE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:BETTE
Last Name:WIENER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 AVON RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9721
Mailing Address - Country:US
Mailing Address - Phone:585-243-3450
Mailing Address - Fax:585-243-3975
Practice Address - Street 1:4050 AVON RD
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9721
Practice Address - Country:US
Practice Address - Phone:585-243-3450
Practice Address - Fax:585-243-3975
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206140163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool