Provider Demographics
NPI:1902898158
Name:VANBUREN, KATHLEEN (CPNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:VANBUREN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3292
Mailing Address - Country:US
Mailing Address - Phone:610-326-8660
Mailing Address - Fax:610-326-8408
Practice Address - Street 1:1610 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3292
Practice Address - Country:US
Practice Address - Phone:610-326-8660
Practice Address - Fax:610-326-8408
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP002074D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS98687Medicare UPIN
PA035220Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER