Provider Demographics
NPI:1306397872
Name:HEALY, KATHALEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHALEEN
Middle Name:
Last Name:HEALY
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 1:110 WEST 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126
Mailing Address - Country:US
Mailing Address - Phone:315-326-4227
Mailing Address - Fax:
Practice Address - Street 1:110 WEST 6TH STREET
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-326-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576903163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354485Medicaid
NY70091AOtherMEDICARE ID TYPE UNSPECIFIED
NY00914154Medicaid
NY01414960Medicaid
NY02369919Medicaid
NY01271109Medicaid
NY0271856Medicaid
0650370001Medicare NSC
NY01414960Medicaid
NY0271856Medicaid