Healthcare Provider Details

I. General information

NPI: 1477816387
Provider Name (Legal Business Name): KATEA CORINDA DALE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20920 HILLSIDE AVE
QUEENS VILLAGE NY
11427-1715
US

IV. Provider business mailing address

20920 HILLSIDE AVE
QUEENS VILLAGE NY
11427-1715
US

V. Phone/Fax

Practice location:
  • Phone: 518-229-3539
  • Fax:
Mailing address:
  • Phone: 518-229-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: