Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 308438 | NY |
NPI | 1235648858 |
---|---|
Provider Name | Kathryn D Alder |
First Address | Camillus, NY 13031-1678 |
Second Address | Camillus, NY 13031-1678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2017 |
Last Update Date | 26/09/2017 |