Healthcare Provider Details

I. General information

NPI: 1619137486
Provider Name (Legal Business Name): CATHERINE DERENONCOURT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 W MAPLE AVE APT 1
SUFFERN NY
10901-5813
US

IV. Provider business mailing address

44 W MAPLE AVE APT 1
SUFFERN NY
10901-5813
US

V. Phone/Fax

Practice location:
  • Phone: 845-200-0151
  • Fax:
Mailing address:
  • Phone: 845-200-0151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026021962
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number231020
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17881800
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN305475
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number695000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: