Healthcare Provider Details

I. General information

NPI: 1568386357
Provider Name (Legal Business Name): LUMARA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W LANCASTER AVE STE 215
DEVON PA
19333-1585
US

IV. Provider business mailing address

237 W LANCASTER AVE STE 215
DEVON PA
19333-1585
US

V. Phone/Fax

Practice location:
  • Phone: 610-267-2468
  • Fax:
Mailing address:
  • Phone: 610-267-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KATHRYN MATULIEWICH
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 610-267-2468