Doctor Name: | KATHLEEN PATRICIA ERCOLANI |
NPI Number: | 1053749770 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SP013083 |
Business Practice Address: | 677 Kidder St Wilkes Barre, PA - 187026908 |
Business Phone Number: | 5708252046 |
Business Fax Number: | 5708252308 |
Mailing Address: | 677 Kidder St, WILKES BARRE |
State: | PA |
Postal Code: | 187026908 |
Phone Number: | 5708252046 |
Fax Number: | 5708252308 |
NPI Enumeration Date: | 10/15/2013 |
NPI Last Update Date: | 10/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP013083 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |