Provider Demographics
NPI:1871827956
Name:SALTARELLI, KATELYN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:SALTARELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 ASHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1219
Mailing Address - Country:US
Mailing Address - Phone:989-772-1500
Mailing Address - Fax:
Practice Address - Street 1:1970 ASHLAND DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1219
Practice Address - Country:US
Practice Address - Phone:989-772-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005634363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant