Provider Demographics
NPI:1396223525
Name:SPANGLER, KATRINA RENEE
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:RENEE
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 MEMORIAL BLVD STE B-1
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1419
Mailing Address - Country:US
Mailing Address - Phone:724-628-3944
Mailing Address - Fax:724-628-3798
Practice Address - Street 1:2618 MEMORIAL BLVD STE B-1
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1419
Practice Address - Country:US
Practice Address - Phone:724-628-3944
Practice Address - Fax:724-628-3798
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP019065OtherSTATE LICENSE