Provider Demographics
NPI:1447479266
Name:BOHNDORF, KATHY ANN (RNC BS)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:BOHNDORF
Suffix:
Gender:F
Credentials:RNC BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 COUNTRY ROAD 23
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460
Mailing Address - Country:US
Mailing Address - Phone:607-674-9567
Mailing Address - Fax:607-674-9567
Practice Address - Street 1:766 TURNPIKE ROAD
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460
Practice Address - Country:US
Practice Address - Phone:607-674-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2689941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01962270Medicaid