Healthcare Provider Details

I. General information

NPI: 1649924507
Provider Name (Legal Business Name): KATHRYN PLOTKIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAPLE AVE
HONESDALE PA
18431-1459
US

IV. Provider business mailing address

601 PARK ST
HONESDALE PA
18431-1445
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-8219
  • Fax:
Mailing address:
  • Phone: 570-253-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP025342
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: