Provider Demographics
NPI:1700387669
Name:KLECAN, KATHRYN E (RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:KLECAN
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 1:34 RAYNOR RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-1904
Mailing Address - Country:US
Mailing Address - Phone:631-205-1250
Mailing Address - Fax:
Practice Address - Street 1:34 RAYNOR RD
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-1904
Practice Address - Country:US
Practice Address - Phone:631-205-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494636-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse