Provider Demographics
NPI:1194235481
Name:SERRAVALLE, KATE (MS)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:SERRAVALLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S 9TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5107
Mailing Address - Country:US
Mailing Address - Phone:267-772-4040
Mailing Address - Fax:
Practice Address - Street 1:945 DUKE ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7216
Practice Address - Country:US
Practice Address - Phone:717-274-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program