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General NPI Number Information
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NPI Number | 1033464854
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Entity Type | Individual
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Provider Name | KATHLEEN MARY THALER FNP
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Gender | Female
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 21 EDWARD J. LEMPKA DRIVE
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City | FLORIDA
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State | NY
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Zip | 10921
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Country | US
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Telephone | 845-341-3837
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 265 44 SHORE DRIVE
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City | BLOOMING GROVE
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State | NY
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Zip | 10914
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Country | US
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Telephone | 845-496-1310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 337465
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License Number State | NY
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