Provider Demographics
NPI:1558491910
Name:RENDICH, KATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:RENDICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 ROUTE 44
Mailing Address - Street 2:
Mailing Address - City:SALT POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12578-8040
Mailing Address - Country:US
Mailing Address - Phone:845-677-8358
Mailing Address - Fax:
Practice Address - Street 1:71 PROSPECT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534
Practice Address - Country:US
Practice Address - Phone:518-828-2565
Practice Address - Fax:518-828-4055
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily