| Doctor Name: | MR. TAVERSHIMA ASOM |
| NPI Number: | 1881923720 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSN, RN, NP-C |
| License Number: | SP010531 |
| Business Practice Address: | 12 Kevin Ln Brodheadsville, PA - 183229731 |
| Business Phone Number: | 5709927620 |
| Business Fax Number: | 5709929884 |
| Mailing Address: | Po Box 1754, ALLENTOWN |
| State: | PA |
| Postal Code: | 181051754 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/23/2009 |
| NPI Last Update Date: | 08/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | SP010531 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |