Provider Demographics
NPI:1487647756
Name:JESIOLOWSKI, KATHLEEN (CRNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:JESIOLOWSKI
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 1:615 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5233
Mailing Address - Country:US
Mailing Address - Phone:717-273-6741
Mailing Address - Fax:717-273-6337
Practice Address - Street 1:120 S TAN ALY STE 1
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026-9349
Practice Address - Country:US
Practice Address - Phone:717-865-6644
Practice Address - Fax:717-865-5666
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006006B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
50000765OtherCAPITAL BLUE CROSS
50000765OtherCAPITAL BLUE CROSS
P09973Medicare UPIN