Provider Demographics
NPI:1184638918
Name:DEMUTIS, KATHLEEN O (CRNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:O
Last Name:DEMUTIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:255 W. LANCASTER AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:610-786-3200
Mailing Address - Fax:610-786-3208
Practice Address - Street 1:255 W LANCASTER AVE STE 330
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1766
Practice Address - Country:US
Practice Address - Phone:610-786-3200
Practice Address - Fax:610-786-3208
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004650C363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner