Healthcare Provider Details

I. General information

NPI: 1285560052
Provider Name (Legal Business Name): CATHERINE GRACE MCCUTCHEON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE GRACE HANLON RN

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FOX RD
MIDDLE GROVE NY
12850-1425
US

IV. Provider business mailing address

130 FOX RD
MIDDLE GROVE NY
12850-1425
US

V. Phone/Fax

Practice location:
  • Phone: 518-258-1994
  • Fax:
Mailing address:
  • Phone: 518-258-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360052-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: