Healthcare Provider Details

I. General information

NPI: 1891423281
Provider Name (Legal Business Name): BRITTANY TERESE CAVANAUGH CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY TERESE CAVANAUGH

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 W BROAD ST
HAZLETON PA
18201-6108
US

IV. Provider business mailing address

2100 MACK BLVD FL 4
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 484-884-4500
  • Fax:
Mailing address:
  • Phone: 484-884-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN707599
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP026032
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: