Provider Demographics
NPI:1831653070
Name:FREY, KATHERINE JANE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JANE
Last Name:FREY
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 1:409 LOPAX RD APT I13
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4513
Mailing Address - Country:US
Mailing Address - Phone:814-367-7480
Mailing Address - Fax:
Practice Address - Street 1:10228 DUPONT CIRCLE DR E STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1611
Practice Address - Country:US
Practice Address - Phone:260-222-7401
Practice Address - Fax:260-209-5956
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010507176B00000X
IN28248486A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse