Healthcare Provider Details

I. General information

NPI: 1902852742
Provider Name (Legal Business Name): KATHERINE TANNER CULTRARA PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 NEW SCOTLAND RD SUITE 100
SLINGERLANDS NY
12159-9222
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-475-7000
  • Fax: 518-474-7050
Mailing address:
  • Phone: 518-525-5634
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF380358
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: