Healthcare Provider Details

I. General information

NPI: 1215408299
Provider Name (Legal Business Name): KATE MARIE KOCAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 FRONT ST
BINGHAMTON NY
13905-2424
US

IV. Provider business mailing address

107 N HUDSON ST
JOHNSON CITY NY
13790-1412
US

V. Phone/Fax

Practice location:
  • Phone: 607-206-7066
  • Fax:
Mailing address:
  • Phone: 607-644-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number331312-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: