Healthcare Provider Details

I. General information

NPI: 1649927005
Provider Name (Legal Business Name): SIERRA SCHALLER-MAHL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSTETLER RD
JOHNSTOWN PA
15904-3111
US

IV. Provider business mailing address

100 HOSTETLER RD
JOHNSTOWN PA
15904-3111
US

V. Phone/Fax

Practice location:
  • Phone: 814-240-3432
  • Fax:
Mailing address:
  • Phone: 814-240-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP025431
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP025431
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: