Provider Demographics
NPI:1356794119
Name:POLLOCK, KATHLEEN (CRNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GREEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1507
Mailing Address - Country:US
Mailing Address - Phone:717-766-4911
Mailing Address - Fax:717-506-3946
Practice Address - Street 1:1 GREEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1507
Practice Address - Country:US
Practice Address - Phone:717-766-4911
Practice Address - Fax:717-506-3946
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006107B163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator