Provider Demographics
NPI:1932160017
Name:MCGOLDRICK, KATHI JO (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:JO
Last Name:MCGOLDRICK
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Gender:F
Credentials:CRNA
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Mailing Address - Street 1:11781 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:571-777-5102
Mailing Address - Fax:703-563-6256
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:NORTH AMERICAN PARRTNERS IN ANESTHESIA, PA, LLC
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-421-4000
Practice Address - Fax:570-476-3754
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-05-03
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Provider Licenses
StateLicense IDTaxonomies
PARN356641L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101001PZPMedicare PIN
PA101001VKCMedicare PIN