Healthcare Provider Details

I. General information

NPI: 1063010965
Provider Name (Legal Business Name): MARY ELIZABETH WILCHER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20397 ROUTE 19 STE 330
CRANBERRY TOWNSHIP PA
16066-6133
US

IV. Provider business mailing address

20397 ROUTE 19 STE 330
CRANBERRY TOWNSHIP PA
16066-6133
US

V. Phone/Fax

Practice location:
  • Phone: 724-772-3300
  • Fax: 724-772-3360
Mailing address:
  • Phone: 724-772-3300
  • Fax: 724-772-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022398
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: