Organization Name: | PORT ALLEGANY AREA FAMILY PRACTICE PC |
NPI Number: | 1962469486 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK H SHELLEY (PRESIDENT) |
Mailing Address: | 1 Willow St Port Allegany |
State: | PA US |
Postal Code: | 167431332 |
Phone Number: | 8146429531 |
Fax Number: | 8146422020 |
NPI Enumeration Date: | 04/27/2006 |
NPI Last Update Date: | 11/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP008214 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |