Provider Demographics
NPI:1497931356
Name:FIELD, KATHRYN E (RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:FIELD
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 1:104 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1523
Mailing Address - Country:US
Mailing Address - Phone:631-988-0835
Mailing Address - Fax:
Practice Address - Street 1:104 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1523
Practice Address - Country:US
Practice Address - Phone:631-988-0835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350856-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY350856-1Medicaid