Provider Demographics
NPI:1801118674
Name:BATES, KAITLYN EILEEN (KAITLYN BATES RN)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:EILEEN
Last Name:BATES
Suffix:
Gender:F
Credentials:KAITLYN BATES RN
Other - Prefix:MRS
Other - First Name:KAITLYN
Other - Middle Name:EILEEN
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4472 S ONONDAGA RD
Mailing Address - Street 2:
Mailing Address - City:NEDROW
Mailing Address - State:NY
Mailing Address - Zip Code:13120-9766
Mailing Address - Country:US
Mailing Address - Phone:315-345-3314
Mailing Address - Fax:
Practice Address - Street 1:4472 S ONONDAGA RD
Practice Address - Street 2:
Practice Address - City:NEDROW
Practice Address - State:NY
Practice Address - Zip Code:13120-9766
Practice Address - Country:US
Practice Address - Phone:315-345-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY613112-1163W00000X
CT088554163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse