Provider Demographics
NPI:1639317381
Name:NABYWANIEC, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:NABYWANIEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-6227
Mailing Address - Country:US
Mailing Address - Phone:607-669-4629
Mailing Address - Fax:
Practice Address - Street 1:337 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-6227
Practice Address - Country:US
Practice Address - Phone:607-669-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY579415052174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist