Provider Demographics
NPI:1316907728
Name:MANSUR, KATIE JEANNE (CNM)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JEANNE
Last Name:MANSUR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3110
Mailing Address - Country:US
Mailing Address - Phone:302-658-2229
Mailing Address - Fax:302-658-2382
Practice Address - Street 1:1508 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3110
Practice Address - Country:US
Practice Address - Phone:302-658-2229
Practice Address - Fax:302-658-2382
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010059L367A00000X
DELK-0000143367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELK-0000143OtherNURSE MIDWIFE LICENSE
PAMW010059LOtherNURSE MIDWIFE LICENSE