Provider Demographics
NPI:1417650706
Name:KPLIVI, EDITH (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:KPLIVI
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6688
Mailing Address - Country:US
Mailing Address - Phone:240-595-5497
Mailing Address - Fax:240-720-0342
Practice Address - Street 1:28 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6688
Practice Address - Country:US
Practice Address - Phone:240-595-5497
Practice Address - Fax:240-720-0342
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR148057363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health