Healthcare Provider Details

I. General information

NPI: 1487991691
Provider Name (Legal Business Name): BETH ANN KOTARSKI C.R.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 02/21/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MERION AVE
BRYN MAWR PA
19010-2859
US

IV. Provider business mailing address

300 JOY LN
WEST CHESTER PA
19380-5110
US

V. Phone/Fax

Practice location:
  • Phone: 610-526-7360
  • Fax: 610-526-7365
Mailing address:
  • Phone: 610-918-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberVP006640B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: