Provider Demographics
NPI:1972687721
Name:VITERISE, KATHLEEN (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:VITERISE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MERIDIAN CENTRE BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3984
Mailing Address - Country:US
Mailing Address - Phone:585-236-6500
Mailing Address - Fax:
Practice Address - Street 1:435 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4629
Practice Address - Country:US
Practice Address - Phone:585-760-5466
Practice Address - Fax:585-760-5467
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332268363L00000X
NYF332268-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02565199Medicaid
NYJ400001046Medicare PIN
NY02565199Medicaid
NYJ400014241Medicare PIN