Healthcare Provider Details

I. General information

NPI: 1699211029
Provider Name (Legal Business Name): KATHERINE OLMSTEAD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 PINE ST
PHILADELPHIA PA
19103-6711
US

IV. Provider business mailing address

1632 PINE ST
PHILADELPHIA PA
19103-6711
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-7992
  • Fax:
Mailing address:
  • Phone: 215-735-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017029
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00927800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: