Individual
KATIE WETHERILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
550 BROAD ST STE 606, NEWARK, NJ 07102-4537
(201) 822-1161
(877) 485-8918
Mailing address
134 ARCH ST, APT 501, PHILADELPHIA, PA 19106-2266
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
26NJ00103500
NJ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ00103500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112771
—
NJ
Enumeration date
08/07/2006
Last updated
09/20/2024
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