Healthcare Provider Details

I. General information

NPI: 1548036619
Provider Name (Legal Business Name): MISS KATIE LYNN INGOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SMITH DR STE 3
CRANBERRY TWP PA
16066-4131
US

IV. Provider business mailing address

301 SMITH DR STE 3
CRANBERRY TWP PA
16066-4131
US

V. Phone/Fax

Practice location:
  • Phone: 724-779-2010
  • Fax: 724-779-2011
Mailing address:
  • Phone: 724-779-2010
  • Fax: 724-779-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberPN296898
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: