Provider Demographics
NPI:1215164900
Name:BROWNELL, KATRINA DENISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:DENISE
Last Name:BROWNELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 DEVOE RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-3602
Mailing Address - Country:US
Mailing Address - Phone:315-942-3102
Mailing Address - Fax:
Practice Address - Street 1:113 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-1215
Practice Address - Country:US
Practice Address - Phone:315-942-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093362-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse