Basic Information
Provider Information
NPI: 1346518438
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BATES-ENDER
FirstName: KATHERINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16561 TIGHT PINCH RD
Address2:  
City: PLEASANTVILLE
State: PA
PostalCode: 163411417
CountryCode: US
TelephoneNumber: 8145897577
FaxNumber:  
Practice Location
Address1: 2 W CRESCENT PARK
Address2:  
City: WARREN
State: PA
PostalCode: 163652111
CountryCode: US
TelephoneNumber: 8147234973
FaxNumber: 8147236095
Other Information
ProviderEnumerationDate: 12/05/2011
LastUpdateDate: 12/05/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XSP003341BPAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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