Facts
- Status
- A
- Credential
- LSW
- Type
- Individual
- Enumeration date
- 2023-01-05
- Last updated
- 2023-01-05
Specialties
Licenses
- License PA
- SW139949
Location
- Practice location
- 63 3RD ST
- City
- MANSFIELD PA
- Postal code
- 169331262
- Phone
- 570-662-7600
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.