Provider Demographics
NPI:1699211029
Name:OLMSTEAD, KATHERINE (CRNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6711
Mailing Address - Country:US
Mailing Address - Phone:215-735-7992
Mailing Address - Fax:
Practice Address - Street 1:1632 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6711
Practice Address - Country:US
Practice Address - Phone:215-735-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017029363LF0000X
NJ26NJ00927800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103263269Medicaid
PA563633Medicare PIN