MEDICARE: MS. KATHRYN SPIKER TUMELTY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0050-00980	NC
2	363LF0000X	Family Nurse Practitioner	SP009364	PA
3	363LF0000X	Family Nurse Practitioner	RN580910L	PA

General Provider Information

NPI Number	:	1689621286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN SPIKER TUMELTY NP

Provider Business Mailing Address
First Line	:	333 COTTMAN AVE
Second Line	:	FOX CHASE CANCER CENTER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2497
Country	:	US
Telephone Number	:	215-214-3736
Fax Number	:	215-214-4017

Provider Business Practice Location Address
First Line	:	333 COTTMAN AVE
Second Line	:	FOX CHASE CANCER CENTER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2497
Country	:	US
Telephone Number	:	215-214-3736
Fax Number	:	215-214-4017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	10/23/2007

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