Provider Demographics
NPI:1699771139
Name:REPINE, KAMIE DEE (CRNP)
Entity type:Individual
Prefix:
First Name:KAMIE
Middle Name:DEE
Last Name:REPINE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KAMIE
Other - Middle Name:D
Other - Last Name:COTTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:717 STATE STREET, SUITE 16 LL
Mailing Address - Street 2:REGIONAL HEALTH SERVICES, INC.
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1360
Mailing Address - Country:US
Mailing Address - Phone:814-877-7100
Mailing Address - Fax:814-877-2939
Practice Address - Street 1:2 CRESCENT PARK WEST
Practice Address - Street 2:WARREN FACULTY SPECIALISTS
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2111
Practice Address - Country:US
Practice Address - Phone:814-723-3300
Practice Address - Fax:814-451-0443
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102194800Medicaid
PA102194800Medicaid
PA092658Medicare PIN