Provider Demographics
NPI:1326215930
Name:WEBER, KATHERINE LYNNE
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LYNNE
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:LYNNE
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:76 PEARL ST W
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1324
Mailing Address - Country:US
Mailing Address - Phone:607-226-7658
Mailing Address - Fax:
Practice Address - Street 1:76 PEARL ST W
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1324
Practice Address - Country:US
Practice Address - Phone:607-436-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244302-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse