Provider Demographics
NPI:1922396316
Name:CHIU, KATHLEEN MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:CHIU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:519 W 114TH ST
Mailing Address - Street 2:MC3601
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027
Mailing Address - Country:US
Mailing Address - Phone:212-854-9840
Mailing Address - Fax:212-854-0176
Practice Address - Street 1:519 W 114TH ST
Practice Address - Street 2:MC3601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-854-9840
Practice Address - Fax:212-854-0176
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily