Provider Demographics
NPI:1518924687
Name:DOYLE, KATHERINE MICHELLE (CNM, LM)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:CNM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-4832
Mailing Address - Country:US
Mailing Address - Phone:518-322-1992
Mailing Address - Fax:518-203-3409
Practice Address - Street 1:126 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-4832
Practice Address - Country:US
Practice Address - Phone:518-322-1992
Practice Address - Fax:518-203-3409
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000845367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02489614Medicaid
NYDD0829Medicare ID - Type Unspecified
NYDD0829Medicare PIN
NY02489614Medicaid