Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 340744-1 | NY |
NPI | 1023240116 |
---|---|
Provider Name | Ms. Kathryn Ellen Ericksen |
First Address | Binghamton, NY 13903-5513 |
Second Address | Vestal, NY 13850-2229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2009 |
Last Update Date | 22/08/2009 |