Provider Demographics
NPI:1629145776
Name:THOMAS, CATHERINE M (CRNA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:PETRICEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1450 WESTERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3539
Mailing Address - Country:US
Mailing Address - Phone:518-463-0050
Mailing Address - Fax:578-207-7973
Practice Address - Street 1:1450 WESTERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3539
Practice Address - Country:US
Practice Address - Phone:518-463-0050
Practice Address - Fax:578-207-7973
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY516176-1367500000X
NY516176163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR7C69WP291Medicare PIN