Organization
PRACTITIONER LLC
Active
Organization
PRACTITIONER LLC
Active
Other names
NP Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NINO KAVTARADZE CRNP (PRIMARY CARE PROVIDER, SHAREHOLDER)
(267) 223-7738
Entity
Organization
Contact information
Practice address
1200 BUSTLETON PIKE STE 16A3, FEASTERVILLE TREVOSE, PA 19053-4118
(267) 223-7738
(877) 416-0367
Mailing address
1200 BUSTLETON PIKE STE 16A3, FEASTERVILLE TREVOSE, PA 19053-4118
(267) 223-7738
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1037033750001
—
PA
Enumeration date
06/25/2019
Last updated
01/29/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up