Provider Demographics
NPI:1184878878
Name:CORP, KATHLEEN L (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:L
Last Name:CORP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DEWEY AVE
Mailing Address - Street 2:PRUYN HILL
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-2106
Mailing Address - Country:US
Mailing Address - Phone:518-663-1117
Mailing Address - Fax:
Practice Address - Street 1:14 DEWEY AVE
Practice Address - Street 2:PRUYN HILL
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-2106
Practice Address - Country:US
Practice Address - Phone:518-664-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-08
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY593340163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health