Provider Demographics
NPI:1801886411
Name:ALVANITAKIS, KATHIE ANNE (CRNP)
Entity type:Individual
Prefix:MS
First Name:KATHIE
Middle Name:ANNE
Last Name:ALVANITAKIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KATHIE
Other - Middle Name:ANNE
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4413
Practice Address - Country:US
Practice Address - Phone:717-412-7859
Practice Address - Fax:717-965-3214
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006055B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102942914Medicaid
PA102942914Medicaid
PA359183Medicare PIN