Provider Demographics
NPI:1336239615
Name:ATTREED, KATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ATTREED
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 1:158 N MAIN ST
Mailing Address - Street 2:PO BOX 299
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-1133
Mailing Address - Country:US
Mailing Address - Phone:845-651-1412
Mailing Address - Fax:845-651-1510
Practice Address - Street 1:1460 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1054
Practice Address - Country:US
Practice Address - Phone:845-469-4211
Practice Address - Fax:845-469-2339
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335034363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF335034OtherNP LICENSE
NY544209OtherRN LICENSE
MA1449455OtherDEA