Healthcare Provider Details

I. General information

NPI: 1710134382
Provider Name (Legal Business Name): KATHERINE ELLEN DUDA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 FAY RD
SYRACUSE NY
13219-3009
US

IV. Provider business mailing address

813 FAY RD
SYRACUSE NY
13219-3009
US

V. Phone/Fax

Practice location:
  • Phone: 315-488-2831
  • Fax:
Mailing address:
  • Phone: 315-488-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number454928
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: