Provider Demographics
NPI:1962103648
Name:LANDRON, KATHERINE JULIETTE (MSPAS, PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JULIETTE
Last Name:LANDRON
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5670
Mailing Address - Country:US
Mailing Address - Phone:862-262-3967
Mailing Address - Fax:
Practice Address - Street 1:1756 SHARON DR
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5670
Practice Address - Country:US
Practice Address - Phone:862-262-3967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064397363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical