Provider Demographics
NPI:1265780399
Name:PARDAVE, KATHARINE LEE (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:LEE
Last Name:PARDAVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:KATHARINE
Other - Middle Name:ROSEMARY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1016 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1814
Mailing Address - Country:US
Mailing Address - Phone:818-545-0785
Mailing Address - Fax:
Practice Address - Street 1:1530 E CHEVY CHASE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4163
Practice Address - Country:US
Practice Address - Phone:818-545-7418
Practice Address - Fax:818-844-0288
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447387363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care