Healthcare Provider Details

I. General information

NPI: 1114227444
Provider Name (Legal Business Name): STEPHANIE RADEMACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W PLUM ST STE 750
EDINBORO PA
16412-2169
US

IV. Provider business mailing address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-5430
  • Fax: 814-314-2901
Mailing address:
  • Phone: 814-333-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054571
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: