Provider Demographics
NPI:1457497638
Name:BOND, KATHERINE ARIEL (LPN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ARIEL
Last Name:BOND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 OLD TOWN RD
Mailing Address - Street 2:APT 5A
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2200
Mailing Address - Country:US
Mailing Address - Phone:631-456-1774
Mailing Address - Fax:
Practice Address - Street 1:460 OLD TOWN RD
Practice Address - Street 2:APT 5A
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2200
Practice Address - Country:US
Practice Address - Phone:631-456-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284703164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02769551Medicaid