Healthcare Provider Details

I. General information

NPI: 1467752360
Provider Name (Legal Business Name): KACY C NATALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE EMERGENCY DEPARTMENT
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

114 E MORELAND AVE
PHILADELPHIA PA
19118
US

V. Phone/Fax

Practice location:
  • Phone: 484-476-2285
  • Fax:
Mailing address:
  • Phone: 267-414-3591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054672
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: