Provider Demographics
NPI:1801082110
Name:SEKULOVSKI, KATIE W (CNM)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:W
Last Name:SEKULOVSKI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:A
Other - Last Name:WEART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 N UNION ST
Mailing Address - Street 2:STCHCN/UPC
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2736
Mailing Address - Country:US
Mailing Address - Phone:716-375-7500
Mailing Address - Fax:716-701-6853
Practice Address - Street 1:135 N UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2736
Practice Address - Country:US
Practice Address - Phone:716-375-7500
Practice Address - Fax:716-701-6852
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001290-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02917715Medicaid
NYRB5865Medicare PIN
NY02917715Medicaid