Provider Demographics
NPI:1144903915
Name:HETRO, KATRINA LYNN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LYNN
Last Name:HETRO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:LYNN
Other - Last Name:LUTECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 ROARING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:HUNLOCK CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18621-3133
Mailing Address - Country:US
Mailing Address - Phone:570-362-9123
Mailing Address - Fax:
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0001
Practice Address - Country:US
Practice Address - Phone:570-808-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027936363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner