MEDICARE: KATHRYN M. PERNICE N.P.

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	363LW0102X	Women's Health Nurse Practitioner	F4201841	NY

General Provider Information

NPI Number	:	1538383195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN M. PERNICE N.P.

Provider Business Mailing Address
First Line	:	55 INTERLOCHEN PKWY
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-1223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 ROUTE 32
Second Line	:
City	:	CENTRAL VALLEY
State	:	NY
Zip	:	10917-3201
Country	:	US
Telephone Number	:	845-928-8185
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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