Provider Demographics
NPI:1255526745
Name:HATCH, DEBRA KATHERINE (RN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:KATHERINE
Last Name:HATCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 DOROTHY ST
Mailing Address - Street 2:
Mailing Address - City:MINOA
Mailing Address - State:NY
Mailing Address - Zip Code:13116-1110
Mailing Address - Country:US
Mailing Address - Phone:315-656-0214
Mailing Address - Fax:
Practice Address - Street 1:140 DOROTHY ST
Practice Address - Street 2:
Practice Address - City:MINOA
Practice Address - State:NY
Practice Address - Zip Code:13116-1110
Practice Address - Country:US
Practice Address - Phone:315-656-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244720-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02883049Medicaid