Healthcare Provider Details

I. General information

NPI: 1285604181
Provider Name (Legal Business Name): KATHLEEN A SPACHMANN RN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S COBBS CREEK PKWY
PHILADELPHIA PA
19139-3723
US

IV. Provider business mailing address

225 S COBBS CREEK PKWY
PHILADELPHIA PA
19139-3723
US

V. Phone/Fax

Practice location:
  • Phone: 215-476-2223
  • Fax: 215-476-3981
Mailing address:
  • Phone: 215-476-2223
  • Fax: 215-476-3981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNO06899300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNJ00078300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberTP001845D
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN280006L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: