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General NPI Number Information
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NPI Number | 1114936994
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Entity Type | Individual
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Provider Name | KATIE WETHERILL APN
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Gender | Female
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 550 BROAD ST STE 606
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City | NEWARK
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State | NJ
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Zip | 07102-4537
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Country | US
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Telephone | 201-822-1161
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Fax | 877-485-8918
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Provider Business Mailing Address
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Address Line | 134 ARCH ST APT 501
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City | PHILADELPHIA
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State | PA
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Zip | 19106-2266
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00103500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 26NJ00103500
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License Number State | NJ
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