Healthcare Provider Details

I. General information

NPI: 1063172542
Provider Name (Legal Business Name): DUNCAN RODRIGUEZ PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH
DANVILLE PA
17822-0001
US

IV. Provider business mailing address

2567 EUCLID AVE
DUBOISTOWN PA
17702-6767
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6211
  • Fax:
Mailing address:
  • Phone: 570-350-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP024819
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN703531
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: