Provider Demographics
NPI:1619444825
Name:RODRIGUEZ, KATHERINE GABRIELLE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:GABRIELLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N UNION RD
Mailing Address - Street 2:STE 102
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5367
Mailing Address - Country:US
Mailing Address - Phone:716-839-8000
Mailing Address - Fax:
Practice Address - Street 1:6929 MAPLE DR.
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120
Practice Address - Country:US
Practice Address - Phone:716-345-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty