Healthcare Provider Details

I. General information

NPI: 1144370172
Provider Name (Legal Business Name): KATHERINE HELEN MANION NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date: 09/14/2020
Reactivation Date: 10/07/2020

III. Provider practice location address

1030 E LANCASTER AVE
BRYN MAWR PA
19010-1451
US

IV. Provider business mailing address

PO BOX 22581
NEW YORK NY
10087-2581
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-3225
  • Fax: 610-525-4932
Mailing address:
  • Phone: 610-482-4795
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP022454
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: