1639145857 NPI number — MS. NANCY KATHERINE MCFADDEN MSN,CRNP

Table of content: MS. NANCY KATHERINE MCFADDEN MSN,CRNP (NPI 1639145857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639145857 NPI number — MS. NANCY KATHERINE MCFADDEN MSN,CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCFADDEN
Provider First Name:
NANCY
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN,CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639145857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4754 S CYPRESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUTPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18088-9458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-424-9153
Provider Business Mailing Address Fax Number:
570-424-1046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
447 OFFICE PLAZA
Provider Second Line Business Practice Location Address:
600 PLAZA COURT, SUITE D
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-424-9153
Provider Business Practice Location Address Fax Number:
570-424-1046
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  UP004360B , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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