Provider Demographics
NPI:1831186378
Name:PIEDE, KATHLEEN (NP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:PIEDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2125
Mailing Address - Country:US
Mailing Address - Phone:716-366-4210
Mailing Address - Fax:716-366-3549
Practice Address - Street 1:306 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2125
Practice Address - Country:US
Practice Address - Phone:716-366-4210
Practice Address - Fax:716-366-3549
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420076-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512254OtherINDEPENDENT HEALTH
0200489OtherGHI
0296715OtherGHI PPO
NY01197002Medicaid
Y019094OtherCHAMPUS
0200489OtherGHI