Doctor Name: | KATHRYN HETTINGER |
NPI Number: | 1104235050 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 495291-1 |
Business Practice Address: | 4538 Sweden Walker Rd Brockport, NY - 144202834 |
Business Phone Number: | 5855034058 |
Business Fax Number: | |
Mailing Address: | 4538 Sweden Walker Rd, BROCKPORT |
State: | NY |
Postal Code: | 144202834 |
Phone Number: | 5855034058 |
Fax Number: | |
NPI Enumeration Date: | 08/05/2014 |
NPI Last Update Date: | 08/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WG0000X |
License Number: | 495291-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | General Practice |
Taxonomy Definition: |