Healthcare Provider Details

I. General information

NPI: 1710245014
Provider Name (Legal Business Name): KATHRYN MCCORMICK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HIGHLANDS DR
LITITZ PA
17543-7507
US

IV. Provider business mailing address

1812 CHESTNUT HOLLOW LN
WEST CHESTER PA
19382-6774
US

V. Phone/Fax

Practice location:
  • Phone: 888-393-1338
  • Fax:
Mailing address:
  • Phone: 610-996-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010266
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: