Provider Demographics
NPI:1285604181
Name:SPACHMANN, KATHLEEN A (RN, APN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:SPACHMANN
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S COBBS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3723
Mailing Address - Country:US
Mailing Address - Phone:215-476-2223
Mailing Address - Fax:215-476-3981
Practice Address - Street 1:225 S COBBS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3723
Practice Address - Country:US
Practice Address - Phone:215-476-2223
Practice Address - Fax:215-476-3981
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO06899300163W00000X
NJNJ00078300363LP0200X
PATP001845D363LP0200X
PARN280006L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0058157Medicaid