Provider Demographics
NPI:1568718369
Name:BLOSS, KATHERINE E (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:BLOSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:SANTORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:P.O. BOX 4164
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915
Mailing Address - Country:US
Mailing Address - Phone:207-323-7175
Mailing Address - Fax:866-867-4172
Practice Address - Street 1:75 CRYSTAL RUN RD
Practice Address - Street 2:STE 135
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7009
Practice Address - Country:US
Practice Address - Phone:845-333-7575
Practice Address - Fax:845-333-7139
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY617533-1163W00000X
NY337559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03497972Medicaid
NY03497972Medicaid