Provider Demographics
NPI:1679829097
Name:REDIGER, KATHERINE L (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:L
Last Name:REDIGER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:L
Other - Last Name:SHOCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1000 E EAGER STREET
Mailing Address - Street 2:JOHNS HOPKINS COMMUNITY PHYSICIANS
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-522-9800
Mailing Address - Fax:410-367-2174
Practice Address - Street 1:1000 E EAGER STREET
Practice Address - Street 2:JOHNS HOPKINS COMMUNITY PHYSICIANS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-522-9800
Practice Address - Fax:410-367-2174
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily