=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477191047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY PURSEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2019
-----------------------------------------------------
Last Update Date | 12/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 CHESTER PIKE STE 200
-----------------------------------------------------
City | EDDYSTONE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19022-1377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-485-3800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1164 E CEDARVILLE RD
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19465-7626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-919-5059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH013040L
-----------------------------------------------------
License Number State |
-----------------------------------------------------