# NINO KAVTARADZE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1639574841
- **Gender:** F
- **Credential:** CRNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | RN632493 | PA | — |
| 363L00000X | Nurse Practitioner | SP015632 | PA | Yes |
| 363LF0000X | Family Nurse Practitioner | SP015632 | PA | — |

## Other

- **Enumeration date:** 10/30/2014
- **Last updated:** 11/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1032670520017 | — | PA |
| 01 | — | 33402683 | AMERICAN NURSES CREDENTIALING CENTER (ANCC) | — |
| 01 | — | RN632493 | PENNSYLVANIA DEPARTMENT OF STATE | PA |
| 01 | — | SP015632 | PENNSYLVANIA DEPARTMENT OF STATE | PA |