Provider Demographics
NPI:1104817196
Name:KRIEG, KATHLEEN (CDE RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KRIEG
Suffix:
Gender:F
Credentials:CDE RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6413
Mailing Address - Country:US
Mailing Address - Phone:716-664-8380
Mailing Address - Fax:716-664-8230
Practice Address - Street 1:207 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6413
Practice Address - Country:US
Practice Address - Phone:716-664-8380
Practice Address - Fax:716-664-8230
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232164163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
22220269OtherDIABETES EDUCATOR BOARDS
NY232164OtherRN LICENSE