Healthcare Provider Details

I. General information

NPI: 1326969304
Provider Name (Legal Business Name): KATHRYN ANN DEJONGE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 JAY ST
PHELPS NY
14532-1016
US

IV. Provider business mailing address

33 JAY ST
PHELPS NY
14532-1016
US

V. Phone/Fax

Practice location:
  • Phone: 585-269-4324
  • Fax:
Mailing address:
  • Phone: 585-269-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number34704301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: