Healthcare Provider Details

I. General information

NPI: 1336198084
Provider Name (Legal Business Name): KATHRYN B HAUGH MSSNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WHITE SPRUCE BLVD # 600 SUITE 200
ROCHESTER NY
14623-1607
US

IV. Provider business mailing address

125 WHITE SPRUCE BLVD # 600 SUITE 200
ROCHESTER NY
14623-1607
US

V. Phone/Fax

Practice location:
  • Phone: 585-461-5940
  • Fax:
Mailing address:
  • Phone: 585-461-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF420278
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: