Provider Demographics
NPI:1790146744
Name:LISTOPAD, KATERINA (ANP-C)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:LISTOPAD
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GRANDVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-6623
Mailing Address - Country:US
Mailing Address - Phone:845-614-7001
Mailing Address - Fax:845-614-7001
Practice Address - Street 1:24 GRANDVIEW TRL
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6623
Practice Address - Country:US
Practice Address - Phone:845-614-7001
Practice Address - Fax:845-614-7001
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307372363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health