Provider Demographics
NPI:1881707107
Name:SPADARO, KATHLEEN C (RN, CS)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:C
Last Name:SPADARO
Suffix:
Gender:F
Credentials:RN, CS
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Mailing Address - Street 1:104 BERRYBUSH DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1421
Mailing Address - Country:US
Mailing Address - Phone:412-558-0157
Mailing Address - Fax:724-733-3498
Practice Address - Street 1:5035 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-9348
Practice Address - Country:US
Practice Address - Phone:724-733-3491
Practice Address - Fax:724-733-3498
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS34770Medicare UPIN
PA766430Medicare ID - Type Unspecified