Provider Demographics
NPI:1659632909
Name:WUNDERLICH, KATHLEEN LOUISE (NP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KATHIE
Other - Middle Name:LOUISE
Other - Last Name:WUNDERLICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:160 STONE STREET
Mailing Address - Street 2:PLANNED PARENTHOOD OF THE NORTH COUNTRY NEW YORK INC.
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-782-1818
Mailing Address - Fax:315-788-7937
Practice Address - Street 1:66 BRINKER HOFF STREET
Practice Address - Street 2:PLANNED PARENTHOOD OF THE NORTH COUNTRY NEW YORK, INC.
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-561-0605
Practice Address - Fax:518-561-4522
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360057-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology