Provider Demographics
NPI:1275877615
Name:ELLIOTT, CATHERINE DOMANSKA (CRNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DOMANSKA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ALISON
Other - Last Name:DOMANSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:731 WEST CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-444-7550
Mailing Address - Fax:610-444-4656
Practice Address - Street 1:105 VINEYARD WAY STE 200
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390
Practice Address - Country:US
Practice Address - Phone:610-444-7550
Practice Address - Fax:610-444-4656
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012517363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102783059Medicaid