Healthcare Provider Details

I. General information

NPI: 1033893292
Provider Name (Legal Business Name): DOROTA KETCH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W LANCASTER AVE
DEVON PA
19333-1531
US

IV. Provider business mailing address

1302 WELLESLEY TER
WEST CHESTER PA
19382-6679
US

V. Phone/Fax

Practice location:
  • Phone: 610-999-6141
  • Fax:
Mailing address:
  • Phone: 267-640-7383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP030601
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: