Provider Demographics
NPI:1154819522
Name:HEBDON, KATHLEEN MARIE (RN, CDE, NDPPLC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:HEBDON
Suffix:
Gender:F
Credentials:RN, CDE, NDPPLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1497
Mailing Address - Country:US
Mailing Address - Phone:716-592-9643
Mailing Address - Fax:716-592-8115
Practice Address - Street 1:224 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1497
Practice Address - Country:US
Practice Address - Phone:716-592-9643
Practice Address - Fax:716-592-8115
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY-514906-1163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator