Provider Demographics
NPI:1790088557
Name:EYEGUE-SANDY, KATHERINE (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:EYEGUE-SANDY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:RHOADS 3
Mailing Address - City:PHILADELPIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:215-615-2547
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE ST FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4229
Practice Address - Country:US
Practice Address - Phone:215-615-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010912363LA2100X
DELZ-0000119363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care