Provider Demographics
NPI:1811760150
Name:AUDI, KATHLEEN ANNE (RN MSN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:AUDI
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 COUNTY HIGHWAY 132
Mailing Address - Street 2:
Mailing Address - City:HAGAMAN
Mailing Address - State:NY
Mailing Address - Zip Code:12086-2202
Mailing Address - Country:US
Mailing Address - Phone:518-888-4584
Mailing Address - Fax:
Practice Address - Street 1:196 COUNTY HIGHWAY 132
Practice Address - Street 2:
Practice Address - City:HAGAMAN
Practice Address - State:NY
Practice Address - Zip Code:12086-2202
Practice Address - Country:US
Practice Address - Phone:518-888-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home