Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 320077 | NY |
NPI | 1063642825 |
---|---|
Provider Name | Cathy Marie Page |
First Address | Johnson City, NY 13790-2580 |
Second Address | Johnson City, NY 13790-2107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 23/11/2011 |