Provider Demographics
NPI:1083932701
Name:CASSIDY-DEVITO, KATHARINE (CNM)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:CASSIDY-DEVITO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FITCH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1634
Mailing Address - Country:US
Mailing Address - Phone:607-732-1515
Mailing Address - Fax:607-732-2234
Practice Address - Street 1:600 FITCH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1634
Practice Address - Country:US
Practice Address - Phone:607-732-1515
Practice Address - Fax:607-732-2234
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICMW00131367A00000X
NYF001688-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife