MEDICARE: MISS KATRINA A COLE-BOTTOMLEY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	10315205	NY
2	163W00000X	Registered Nurse	755357-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023443058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATRINA A COLE-BOTTOMLEY RN

Provider Business Mailing Address
First Line	:	61 BULLVILLE RD
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-1813
Country	:	US
Telephone Number	:	845-741-5866
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 BULLVILLE RD
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-1813
Country	:	US
Telephone Number	:	845-741-5866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	09/18/2018

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