Provider Demographics
NPI:1063132488
Name:FAULKNER, CATHERINE MARGARET (FNP-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARGARET
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-5150
Mailing Address - Country:US
Mailing Address - Phone:518-234-2555
Mailing Address - Fax:518-234-3415
Practice Address - Street 1:136 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5150
Practice Address - Country:US
Practice Address - Phone:518-234-2555
Practice Address - Fax:518-234-3415
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY632675Medicaid