Provider Demographics
NPI:1396174579
Name:RICH, KATIE M (CRNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:RICH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:NICKOLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 E NORTH AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-359-3030
Mailing Address - Fax:412-359-3060
Practice Address - Street 1:490 E NORTH AVE STE 207
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-930-0908
Practice Address - Fax:412-930-0925
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013379363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103153561Medicaid