Healthcare Provider Details

I. General information

NPI: 1417069121
Provider Name (Legal Business Name): CATHERINE MARY OKONIEWSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 6TH ST C/O OSWEGO HOSPITAL - SUITE G70
OSWEGO NY
13126-2507
US

IV. Provider business mailing address

94 RATHBURN RD
FULTON NY
13069-4171
US

V. Phone/Fax

Practice location:
  • Phone: 315-349-5760
  • Fax: 315-349-5785
Mailing address:
  • Phone: 315-598-6784
  • Fax: 315-598-3409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330946-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: