Provider Demographics
NPI:1598492662
Name:ANDERSON, CATHERINE (MSN, APRN, AGNP-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MATTIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, AGNP-C
Mailing Address - Street 1:420 E 54TH ST APT 3204
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5588
Mailing Address - Country:US
Mailing Address - Phone:248-953-4392
Mailing Address - Fax:
Practice Address - Street 1:4422 THIRD AVE.
Practice Address - Street 2:MILLS BUILDING, 2ND FLOOR, DEPARTMENT OF SURGERY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:248-953-4393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310814363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health