Healthcare Provider Details

I. General information

NPI: 1487813986
Provider Name (Legal Business Name): KATHLEEN ANN REDOVAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E STATE ST
SHARON PA
16146-3328
US

IV. Provider business mailing address

740 E STATE ST
SHARON PA
16146-3328
US

V. Phone/Fax

Practice location:
  • Phone: 724-983-7200
  • Fax:
Mailing address:
  • Phone: 724-983-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP009832
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: