Provider Demographics
NPI:1891958237
Name:TAIBI, KATHLEEN MARY (RN ANP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:TAIBI
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Gender:F
Credentials:RN ANP
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Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:CARDIOLOGY DIVISION HSC 16 080
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0000
Mailing Address - Country:US
Mailing Address - Phone:631-444-1066
Mailing Address - Fax:631-444-3365
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:CARDIOLOGY DIVISION HSC 16 080
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0000
Practice Address - Country:US
Practice Address - Phone:631-444-1066
Practice Address - Fax:631-444-3365
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
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Provider Licenses
StateLicense IDTaxonomies
NYF301163-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health