Provider Demographics
NPI:1942387220
Name:KATHLEEN C. SPADARO LLC
Entity Type:Organization
Organization Name:KATHLEEN C. SPADARO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPADARO
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, RN
Authorized Official - Phone:724-733-3491
Mailing Address - Street 1:104 BERRYBUSH DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1421
Mailing Address - Country:US
Mailing Address - Phone:412-558-0157
Mailing Address - Fax:724-733-3498
Practice Address - Street 1:5035 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-9348
Practice Address - Country:US
Practice Address - Phone:724-733-3491
Practice Address - Fax:724-733-3498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN334294L364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA766430Medicare ID - Type Unspecified
PAS34770Medicare UPIN