Healthcare Provider Details

I. General information

NPI: 1255971222
Provider Name (Legal Business Name): EMINA VAKUFAC PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST STE 400
ERIE PA
16507-1577
US

IV. Provider business mailing address

120 E 2ND ST FL 4
ERIE PA
16507-1577
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-5600
  • Fax:
Mailing address:
  • Phone: 814-877-5600
  • Fax: 814-877-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA061216
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: