Provider Demographics
NPI:1639506009
Name:BABCOCK, KATIE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9438
Mailing Address - Country:US
Mailing Address - Phone:585-373-9170
Mailing Address - Fax:
Practice Address - Street 1:84 PALMER RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14428-9438
Practice Address - Country:US
Practice Address - Phone:585-373-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433291163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse