Healthcare Provider Details

I. General information

NPI: 1609879642
Provider Name (Legal Business Name): KATHLEEN ANN STALLSMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CENTER STREET
CAMP HILL PA
17089-0001
US

IV. Provider business mailing address

138 FIELDSTONE DR
CARLISLE PA
17013-9036
US

V. Phone/Fax

Practice location:
  • Phone: 717-302-4056
  • Fax: 866-507-6567
Mailing address:
  • Phone: 717-766-4057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN258274L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: