Provider Demographics
NPI:1982234035
Name:DANE, KATELYN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:DANE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:WEEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2123 MILL VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-2194
Mailing Address - Country:US
Mailing Address - Phone:267-475-3879
Mailing Address - Fax:
Practice Address - Street 1:1517 POND RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2253
Practice Address - Country:US
Practice Address - Phone:610-395-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOA005169OtherLICENSE NUMBER