MEDICARE: PATRICIA MARIE DUPAK AGACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP014457	PA
2	363LC0200X	Critical Care Medicine Nurse Practitioner	SP014457	PA

General Provider Information

NPI Number	:	1639575806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MARIE DUPAK AGACNP

Provider Business Mailing Address
First Line	:	100 NORTH ACADEMY AVE.
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 EAST MOUNTAIN BLVD.
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18711-3478
Country	:	US
Telephone Number	:	570-808-7861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	05/25/2016

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