Basic Information
| Provider Information | |||||||||
| NPI: | 1205471489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | TEKAKWITHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 RIDGEVIEW LN | ||||||||
| Address2: | |||||||||
| City: | MARLBORO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125425168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453891572 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126013906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452315600 | ||||||||
| FaxNumber: | 8452315654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2019 | ||||||||
| LastUpdateDate: | 12/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/19/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 633539 | NY | N | Nursing Service Providers | Registered Nurse | 367A00000X | 001981 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.