Provider Demographics
NPI:1790055895
Name:PHALEN, KATHLEEN ELIZABETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:PHALEN
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 1:8 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:607-758-4100
Mailing Address - Fax:607-758-4114
Practice Address - Street 1:8 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3264
Practice Address - Country:US
Practice Address - Phone:607-758-4100
Practice Address - Fax:607-758-4119
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY371573-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool