Provider Demographics
NPI:1104032747
Name:RAESIDE, CATHERINE (CRNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:RAESIDE
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 1:421 W CHEW ST
Mailing Address - Street 2:PHYSICIAN ACCOUNTS
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-776-5100
Mailing Address - Fax:610-663-3113
Practice Address - Street 1:450 W CHEW ST
Practice Address - Street 2:SIGAL CENTER 2ND FLOOR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3434
Practice Address - Country:US
Practice Address - Phone:610-776-5160
Practice Address - Fax:610-606-4457
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006774D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics