Provider Demographics
NPI:1447548193
Name:KANDRYSAWTZ, KATIE N (CRNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:N
Last Name:KANDRYSAWTZ
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 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-1760
Practice Address - Street 1:3065 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-8533
Practice Address - Country:US
Practice Address - Phone:717-851-1750
Practice Address - Fax:717-851-1760
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1602293OtherGATEWAY MEDICARE ASSURED
PA2659362OtherHIGHMARK BLUE SHIELD
PA225522FLTMedicare PIN