Individual
KATHLEEN RENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
57190 MAIN RD, SOUTHOLD, NY 11971-4750
(631) 626-1006
Mailing address
22 PINE CONE LN, ISLANDIA, NY 11749-5512
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
309280
NY
Other
Enumeration date
03/19/2020
Last updated
03/19/2020
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