Provider Demographics
NPI:1831588896
Name:STAATS, KATY
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:STAATS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SELKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:12158-1707
Mailing Address - Country:US
Mailing Address - Phone:518-852-1728
Mailing Address - Fax:
Practice Address - Street 1:25 VAN RENSSELAER DR
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-1491
Practice Address - Country:US
Practice Address - Phone:518-396-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 550806163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool