Provider Demographics
NPI:1043041601
Name:GAYNOR, CATHERINE (RN)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1203
Mailing Address - Country:US
Mailing Address - Phone:860-810-3215
Mailing Address - Fax:
Practice Address - Street 1:15 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1203
Practice Address - Country:US
Practice Address - Phone:860-810-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY741556163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse