MEDICARE: KATHLEEN E DUPERA FNP

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	363LF0000X	Family Nurse Practitioner	348755	NY

General Provider Information

NPI Number	:	1033850250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN E DUPERA FNP

Provider Business Mailing Address
First Line	:	10 PAERDEGAT 4TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4136
Country	:	US
Telephone Number	:	917-346-9166
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PAERDEGAT 4TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4136
Country	:	US
Telephone Number	:	917-346-9166
Fax Number	:

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

Provider Enumeration Date	:	04/03/2022
Last Update Date	:	04/03/2022

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