Healthcare Provider Details

I. General information

NPI: 1881091304
Provider Name (Legal Business Name): KATHERINE ENGEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MEMORIAL AVE
WILLIAMSPORT PA
17701-4725
US

IV. Provider business mailing address

2645 NORTHWAY RD
WILLIAMSPORT PA
17701-8868
US

V. Phone/Fax

Practice location:
  • Phone: 570-322-5433
  • Fax: 570-601-8441
Mailing address:
  • Phone: 570-713-7396
  • Fax: 570-601-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057280
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA057280
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: