Healthcare Provider Details

I. General information

NPI: 1174792592
Provider Name (Legal Business Name): KATHERINE WOOTEN-BIELSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 LOCUST ST PLANNED PARENTHOOD SOUTHEASTERN PA
PHILADELPHIA PA
19107-6734
US

IV. Provider business mailing address

1144 LOCUST ST PLANNED PARENTHOOD SOUTHEASTERN PA
PHILADELPHIA PA
19107-6734
US

V. Phone/Fax

Practice location:
  • Phone: 215-351-5500
  • Fax: 215-351-5594
Mailing address:
  • Phone: 215-351-5500
  • Fax: 215-351-5594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP005210G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: