Provider Demographics
NPI:1497092969
Name:MORDINO, KATHRYN MARIE (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARIE
Last Name:MORDINO
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:MARIE
Other - Last Name:SOUCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 E SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5513
Mailing Address - Country:US
Mailing Address - Phone:617-435-7601
Mailing Address - Fax:
Practice Address - Street 1:21 E SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5513
Practice Address - Country:US
Practice Address - Phone:617-435-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN283154163W00000X, 363L00000X, 363LA2200X
MECNP231559363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health