Healthcare Provider Details

I. General information

NPI: 1689937187
Provider Name (Legal Business Name): MAUREEN ANN NEVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 KEESLER RD
DAMASCUS PA
18415-3588
US

IV. Provider business mailing address

156 KEESLER RD
DAMASCUS PA
18415-3588
US

V. Phone/Fax

Practice location:
  • Phone: 570-224-6830
  • Fax:
Mailing address:
  • Phone: 570-224-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number16329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: