Provider Demographics
NPI:1952774150
Name:MATTHEW, KATELYN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:MATTHEW
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:OB/GYN DEPT.
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-2920
Mailing Address - Country:US
Mailing Address - Phone:570-271-6298
Mailing Address - Fax:570-271-5841
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:OB/GYN DEPT.
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2920
Practice Address - Country:US
Practice Address - Phone:570-271-6298
Practice Address - Fax:570-271-5841
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015341363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health