Healthcare Provider Details

I. General information

NPI: 1245784974
Provider Name (Legal Business Name): KATHERINE J STRUEBING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1983 DAVIS RD
WEST FALLS NY
14170-9631
US

IV. Provider business mailing address

1983 DAVIS RD
WEST FALLS NY
14170-9631
US

V. Phone/Fax

Practice location:
  • Phone: 716-713-7126
  • Fax:
Mailing address:
  • Phone: 716-713-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number589216
License Number StateNY

VIII. Authorized Official

Name: MS. KATHERINE JEAN STRUEBING
Title or Position: SOLE PROPRIETOR
Credential: RN, BSN
Phone: 716-713-7126