Healthcare Provider Details

I. General information

NPI: 1487767430
Provider Name (Legal Business Name): FRANCES MCGLYNN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LAKE ST
DALLAS PA
18612-7752
US

IV. Provider business mailing address

20 WYOMING AVE
DALLAS PA
18612-1528
US

V. Phone/Fax

Practice location:
  • Phone: 570-675-2131
  • Fax:
Mailing address:
  • Phone: 570-881-6022
  • Fax: 570-675-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberVP000548B
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN204480L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: