MEDICARE: KATHRYN M HUTTENBACH CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	287059-1	NY

General Provider Information

NPI Number	:	1780680769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN M HUTTENBACH CRNA

Provider Business Mailing Address
First Line	:	PO BOX 26642
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-6642
Country	:	US
Telephone Number	:	201-804-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 EAST 77TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-0001
Country	:	US
Telephone Number	:	201-804-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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