Provider Demographics
NPI:1568464766
Name:ECKENRODE, CATHERINE B (NP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:B
Last Name:ECKENRODE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RENWICK HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-2143
Mailing Address - Country:US
Mailing Address - Phone:607-273-3161
Mailing Address - Fax:607-273-4979
Practice Address - Street 1:1301 TRUMANSBURG RD
Practice Address - Street 2:STE E
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1397
Practice Address - Country:US
Practice Address - Phone:607-273-3161
Practice Address - Fax:607-273-4979
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1903424Medicaid
NYS71660Medicare UPIN
NYBB3477Medicare ID - Type Unspecified