Provider Demographics
NPI:1538565221
Name:SALVATORE, KATLYN ELIZABETH (CRNP)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:ELIZABETH
Last Name:SALVATORE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 258
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-938-7730
Mailing Address - Fax:215-938-7125
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 258
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-938-7730
Practice Address - Fax:215-938-7125
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103105045Medicaid
PA386457Medicare PIN