Provider Demographics
NPI:1073052189
Name:METREVELI, EKATERINE (CRNP)
Entity Type:Individual
Prefix:
First Name:EKATERINE
Middle Name:
Last Name:METREVELI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BUSTLETON PIKE, ST 16 A 3
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE- TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-2669
Mailing Address - Country:US
Mailing Address - Phone:267-223-7738
Mailing Address - Fax:
Practice Address - Street 1:1200 BUSTLETON PIKE, ST 16 A 3
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE- TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-1905
Practice Address - Country:US
Practice Address - Phone:267-223-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017126363LA2200X
NJ26NJ00709100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health