Provider Demographics
NPI:1770876971
Name:SIMKOVIC, CATHERINE M (CRNA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:SIMKOVIC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST. SUITE K3502
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:814-274-7407
Mailing Address - Fax:814-274-0807
Practice Address - Street 1:1001 MAIN ST. SUITE K3502
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:814-274-7407
Practice Address - Fax:814-274-0807
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN555122367500000X
NY663915367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered