Provider Demographics
NPI:1194276493
Name:STULL, KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:STULL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 CHESTNUT ST FL 17
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3612
Mailing Address - Country:US
Mailing Address - Phone:215-955-5161
Mailing Address - Fax:215-923-6003
Practice Address - Street 1:1101 CHESTNUT ST FL 17
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3612
Practice Address - Country:US
Practice Address - Phone:215-955-5161
Practice Address - Fax:215-923-6003
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA058333363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical