Individual
KATHERINE BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
(718) 667-2591
(718) 667-2586
Mailing address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
(718) 667-2591
(718) 667-2586
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
694394
NY
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
694394
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2997157
—
NY
Enumeration date
06/08/2016
Last updated
03/17/2018
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