Provider Demographics
NPI:1265596142
Name:MAR, KATHERINE MARY (PNP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARY
Last Name:MAR
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W 21ST ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3118
Mailing Address - Country:US
Mailing Address - Phone:212-255-9263
Mailing Address - Fax:
Practice Address - Street 1:21 JUMEL PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4316
Practice Address - Country:US
Practice Address - Phone:212-923-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380517-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics