Provider Demographics
NPI:1548221914
Name:LANKA, KATHLEEN MARY (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:LANKA
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 1:5752 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GALWAY
Mailing Address - State:NY
Mailing Address - Zip Code:12074-2822
Mailing Address - Country:US
Mailing Address - Phone:518-882-9878
Mailing Address - Fax:518-220-9417
Practice Address - Street 1:930 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-6412
Practice Address - Country:US
Practice Address - Phone:518-220-9413
Practice Address - Fax:518-220-9417
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302285-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ22529Medicare UPIN
NYRA4114Medicare ID - Type Unspecified