Provider Demographics
NPI:1245756808
Name:SEMMELROCK, KATHRYN M (AGPCNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:M
Last Name:SEMMELROCK
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MAPLE AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4708
Mailing Address - Country:US
Mailing Address - Phone:914-948-1000
Mailing Address - Fax:914-949-5860
Practice Address - Street 1:170 MAPLE AVE STE 502
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4708
Practice Address - Country:US
Practice Address - Phone:914-948-1000
Practice Address - Fax:914-949-6109
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308316363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health