Healthcare Provider Details

I. General information

NPI: 1548732944
Provider Name (Legal Business Name): DOROTHY JOAN URBANAVAGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2018
Last Update Date: 12/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 BELAIRE RD
BETHLEHEM PA
18017-3501
US

IV. Provider business mailing address

2645 BELAIRE RD
BETHLEHEM PA
18017-3501
US

V. Phone/Fax

Practice location:
  • Phone: 610-597-2924
  • Fax:
Mailing address:
  • Phone: 610-597-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN671355
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: