Doctor Name: | KATHERINE STANBRIDGE-MAINE |
NPI Number: | 1194003491 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 336803 |
Business Practice Address: | 5496 E Taft Rd North Syracuse, NY - 132123784 |
Business Phone Number: | 3155526700 |
Business Fax Number: | 3155526701 |
Mailing Address: | 5496 E Taft Rd, NORTH SYRACUSE |
State: | NY |
Postal Code: | 132123784 |
Phone Number: | 3155526700 |
Fax Number: | 3155526701 |
NPI Enumeration Date: | 08/03/2011 |
NPI Last Update Date: | 08/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 336803 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |