Provider Demographics
NPI:1851866727
Name:MANION, KATHRYN QUINN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:QUINN
Last Name:MANION
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST WINFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13491-2831
Mailing Address - Country:US
Mailing Address - Phone:315-725-6288
Mailing Address - Fax:
Practice Address - Street 1:8393 ELTA DR
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8958
Practice Address - Country:US
Practice Address - Phone:315-698-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022885363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant