Provider Demographics
NPI:1114234143
Name:WHEAT, KATHRYNE JANET (RN)
Entity Type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:JANET
Last Name:WHEAT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:10881 MAIN ST.
Mailing Address - City:PULTENEY
Mailing Address - State:NY
Mailing Address - Zip Code:14874-0168
Mailing Address - Country:US
Mailing Address - Phone:607-868-4008
Mailing Address - Fax:
Practice Address - Street 1:10881 MAIN ST.
Practice Address - Street 2:#0168
Practice Address - City:PULTENEY
Practice Address - State:NY
Practice Address - Zip Code:14874-0168
Practice Address - Country:US
Practice Address - Phone:607-868-4008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301596-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse