Healthcare Provider Details

I. General information

NPI: 1396725792
Provider Name (Legal Business Name): KATHARINE C SPORER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E MANTUA AVE
WENONAH NJ
08090-1950
US

IV. Provider business mailing address

107 E MANTUA AVE
WENONAH NJ
08090-1950
US

V. Phone/Fax

Practice location:
  • Phone: 856-468-6868
  • Fax: 856-464-1855
Mailing address:
  • Phone: 856-468-6868
  • Fax: 856-464-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NO07781900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: