Provider Demographics
NPI:1114147311
Name:NORTHERN NURSE PRACTITIONERS - FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:NORTHERN NURSE PRACTITIONERS - FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:315-786-1924
Mailing Address - Street 1:19472 US ROUTE 11 STE N101
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5387
Mailing Address - Country:US
Mailing Address - Phone:315-786-1924
Mailing Address - Fax:315-786-0823
Practice Address - Street 1:19472 US ROUTE 11 STE N101
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5387
Practice Address - Country:US
Practice Address - Phone:315-786-1924
Practice Address - Fax:315-786-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCBCCMedicaid
NYBA0184Medicare ID - Type Unspecified