Healthcare Provider Details

I. General information

NPI: 1053745604
Provider Name (Legal Business Name): KATHRYN ELIZABETH SPATES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEACE CORPS OFFICE OF MEDICAL SERVICES 1111 20TH ST. NW
WASHINGTON DC
20526-0001
US

IV. Provider business mailing address

PEACE CORPS OFFICE OF MEDICAL SERVICES 1111 20TH ST. NW
WASHINGTON DC
20526-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-692-1634
  • Fax: 202-692-1501
Mailing address:
  • Phone: 202-692-1634
  • Fax: 202-692-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN1002314
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: