Provider Demographics
NPI:1336691328
Name:BRIONES, KATHRYN MENDOZA (RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MENDOZA
Last Name:BRIONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAYE
Other - Middle Name:MENDOZA
Other - Last Name:BRIONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:255 FORT WASHINGTON AVE
Mailing Address - Street 2:45
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1229
Mailing Address - Country:US
Mailing Address - Phone:909-800-6536
Mailing Address - Fax:
Practice Address - Street 1:13 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6003
Practice Address - Country:US
Practice Address - Phone:516-823-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718089-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse