Healthcare Provider Details

I. General information

NPI: 1780909317
Provider Name (Legal Business Name): CARLA JOSEFOSKI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MARION ST
CREIGHTON PA
15030-1041
US

IV. Provider business mailing address

503 MARION ST
CREIGHTON PA
15030-1041
US

V. Phone/Fax

Practice location:
  • Phone: 412-759-9976
  • Fax:
Mailing address:
  • Phone: 412-759-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN270662
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: