Healthcare Provider Details

I. General information

NPI: 1518927946
Provider Name (Legal Business Name): STEPHANIE ANN CHLEBUS-NICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN CHLEBUS PA-C

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 PEACH ST
ERIE PA
16509-2603
US

IV. Provider business mailing address

1 LECOM PL
ERIE PA
16505-2571
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-3488
  • Fax: 814-868-3499
Mailing address:
  • Phone: 814-868-2529
  • Fax: 814-868-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA006345
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA003474L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: