Provider Demographics
NPI:1568753911
Name:KLARICH, MARY KATE (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY KATE
Middle Name:
Last Name:KLARICH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:538 SPRING MILL AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1958
Mailing Address - Country:US
Mailing Address - Phone:267-226-9268
Mailing Address - Fax:215-590-9045
Practice Address - Street 1:34TH STREET & CIVIC CENTER BOULEVARD
Practice Address - Street 2:WOOD AMBULATORY CARE BUILDING 5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:267-226-9268
Practice Address - Fax:215-590-9045
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP010819363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics