| |
136 State St St Marys PA 15857-1626 | |
(814) 781-6758 | |
(814) 834-1038 |
Full Name | |
---|---|
Speciality | Nurse Practitioner |
Location | 136 State St, St Marys, Pennsylvania |
Authorized Official Name and Position | Rita V Olszewski (VICE PRESIDENT, ERPG) |
Authorized Official Contact | 8147888580 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
136 State St St Marys PA 15857-1626 Ph: (814) 781-6758 | 136 State St St Marys PA 15857-1626 Ph: (814) 781-6758 |
NPI Number | 1336136720 |
---|---|
Provider Enumeration Date | 09/30/2005 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336136720 | NPI | - | NPPES |
0018592850010 | Medicaid | PA | |
1418283 | Other | PA | HIGHMARK ASSIGNMENT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
363A00000X | Physician Assistant | (* (Not Available)) | Primary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |