Provider Demographics
NPI:1235648858
Name:ALDER, KATHRYN D (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:ALDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 TOWNSHIP BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1678
Mailing Address - Country:US
Mailing Address - Phone:315-708-0190
Mailing Address - Fax:315-488-3284
Practice Address - Street 1:260 TOWNSHIP BLVD STE 20
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1678
Practice Address - Country:US
Practice Address - Phone:315-708-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308438363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine