| NPI | 1669085544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH WAYMIRE Credentialing 570-693-6163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine |
| 207R00000X Internal Medicine | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |