Provider Demographics
NPI:1649434457
Name:KNIPEL, KATHRYN J
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:KNIPEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S FEATHERING LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4546
Mailing Address - Country:US
Mailing Address - Phone:610-937-2994
Mailing Address - Fax:
Practice Address - Street 1:34TH STREET AND CIVIC CENTER BOULEVARD
Practice Address - Street 2:RICHARD D WOOD AMBULATORY CARE CENTER 3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:267-425-4650
Practice Address - Fax:267-425-4469
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009473363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics