Provider Demographics
NPI:1508814260
Name:ALTNER, KATHLEEN ANN (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:ALTNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 N WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1521
Mailing Address - Country:US
Mailing Address - Phone:516-755-2185
Mailing Address - Fax:
Practice Address - Street 1:31 TEC ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3618
Practice Address - Country:US
Practice Address - Phone:516-478-9303
Practice Address - Fax:516-932-3672
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304288-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse