Healthcare Provider Details

I. General information

NPI: 1255649166
Provider Name (Legal Business Name): CATHY VANHOOF PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 LACKAWANNA AVE
DUPONT PA
18641-2009
US

IV. Provider business mailing address

217 LACKAWANNA AVE
DUPONT PA
18641-2009
US

V. Phone/Fax

Practice location:
  • Phone: 570-654-2901
  • Fax: 570-654-1568
Mailing address:
  • Phone: 570-654-2901
  • Fax: 570-654-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA002537
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: