Provider Demographics
NPI:1124574355
Name:STINSMAN, CATHERINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:STINSMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 BLUE POINT RD
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742
Mailing Address - Country:US
Mailing Address - Phone:631-804-9824
Mailing Address - Fax:
Practice Address - Street 1:1400 DEER PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703
Practice Address - Country:US
Practice Address - Phone:631-669-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340716-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily