Healthcare Provider Details

I. General information

NPI: 1295458834
Provider Name (Legal Business Name): KATHLEEN BESEMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WARREN RD
ITHACA NY
14850-1862
US

IV. Provider business mailing address

555 WARREN RD
ITHACA NY
14850-1862
US

V. Phone/Fax

Practice location:
  • Phone: 607-257-1551
  • Fax: 607-697-8220
Mailing address:
  • Phone: 607-257-1551
  • Fax: 607-697-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number644531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: