Provider Demographics
NPI:1639319437
Name:SHREVE, KATRINA C (LMT, RMP)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:C
Last Name:SHREVE
Suffix:
Gender:F
Credentials:LMT, RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-2137
Mailing Address - Country:US
Mailing Address - Phone:716-499-6895
Mailing Address - Fax:716-679-4646
Practice Address - Street 1:69 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-2137
Practice Address - Country:US
Practice Address - Phone:716-499-6895
Practice Address - Fax:716-679-4646
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY016040172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker