Provider Demographics
NPI:1932636990
Name:ENGBERT, KATELYN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:ENGBERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5312
Mailing Address - Country:US
Mailing Address - Phone:301-461-8526
Mailing Address - Fax:
Practice Address - Street 1:4717 MORGAN DR
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-461-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-20
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000217499163W00000X
MDR229471363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse