Healthcare Provider Details

I. General information

NPI: 1316936230
Provider Name (Legal Business Name): NANCY ELAINE GUMM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 S MAIN ST SUITE 101
GREENSBURG PA
15601-5385
US

IV. Provider business mailing address

1275 S MAIN STREET
GREENSBURG PA
15601-5385
US

V. Phone/Fax

Practice location:
  • Phone: 724-837-3111
  • Fax: 724-837-3022
Mailing address:
  • Phone: 724-837-3111
  • Fax: 724-837-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA000810L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: