Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP021774 | PA |
NPI | 1306464847 |
---|---|
Provider Name | Catherine Waselkov |
First Address | York, PA 17402-9001 |
Second Address | Lebanon, PA 17042-6111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2020 |
Last Update Date | 13/07/2020 |