Provider Demographics
NPI:1124322177
Name:WOHLSTADTER, KATHERINE MARIE (MMS, RPA-C)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARIE
Last Name:WOHLSTADTER
Suffix:
Gender:F
Credentials:MMS, RPA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIA
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMS, RPA-C
Mailing Address - Street 1:226 50TH AVE APT 9B
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4522
Mailing Address - Country:US
Mailing Address - Phone:561-542-7641
Mailing Address - Fax:
Practice Address - Street 1:159 E 74TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3309
Practice Address - Country:US
Practice Address - Phone:212-737-3301
Practice Address - Fax:212-737-4876
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant