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General NPI Number Information
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NPI Number | 1639574841
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Entity Type | Individual
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Provider Name | NINO KAVTARADZE CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1200 BUSTLETON PIKE STE 16A3
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-4118
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Country | US
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Telephone | 267-574-5236
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 BUSTLETON PIKE STE 16A3
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-4118
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Country | US
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Telephone | 267-223-7738
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Fax | 267-223-7738
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP015632
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP015632
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN632493
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License Number State | PA
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