Provider Demographics
NPI:1144370172
Name:MANION, KATHERINE HELEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:HELEN
Last Name:MANION
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:1030 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1451
Practice Address - Country:US
Practice Address - Phone:610-525-3225
Practice Address - Fax:610-525-4932
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-11-30
Deactivation Date:2020-09-14
Deactivation Code:
Reactivation Date:2020-10-07
Provider Licenses
StateLicense IDTaxonomies
PASP022454363LW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3468140OtherFIRST HEALTH
PA6486005OtherAETNA
PA103931272Medicaid
PA004620910OtherHIGHMARK BCBS
PA480752OtherUPMC HEALTH PLAN
PA8510160OtherCIGNA