Provider Demographics
NPI:1104469188
Name:ULRICH, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ULRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4133
Mailing Address - Country:US
Mailing Address - Phone:148-419-8046
Mailing Address - Fax:
Practice Address - Street 1:325 INDUSTRIAL PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4117
Practice Address - Country:US
Practice Address - Phone:814-419-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily