Healthcare Provider Details

I. General information

NPI: 1932683455
Provider Name (Legal Business Name): KAROLINA FEDORYSZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
FOUNTAIN HILL PA
18015-1000
US

IV. Provider business mailing address

462 APPLE BLOSSOM RD
EASTON PA
18040-1148
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSPO19236
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP019236
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: