Healthcare Provider Details

I. General information

NPI: 1922019025
Provider Name (Legal Business Name): KAREN L HATHAWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 ST RT 55
SWAN LAKE NY
12783
US

IV. Provider business mailing address

PO BOX 325 108 STANTON CORNERS RD
SWAN LAKE NY
12783
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-6875
  • Fax:
Mailing address:
  • Phone: 845-292-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number341904-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: