Provider Demographics
NPI:1902189632
Name:MAURER, KATELYN E (PA)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:E
Last Name:MAURER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:E
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4207 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6684
Mailing Address - Country:US
Mailing Address - Phone:919-784-1410
Mailing Address - Fax:919-784-1409
Practice Address - Street 1:4207 LAKE BOONE TRL
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6684
Practice Address - Country:US
Practice Address - Phone:919-784-1410
Practice Address - Fax:919-784-1409
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-003301363A00000X
NC0010-04375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant