Healthcare Provider Details

I. General information

NPI: 1013135284
Provider Name (Legal Business Name): WOMEN TO WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 3RD AVE PARK OFFICE BUILDING 208 209
KINGSTON PA
18704-5816
US

IV. Provider business mailing address

400 3RD AVE PARK OFFICE BUILDING 208 209
KINGSTON PA
18704-5816
US

V. Phone/Fax

Practice location:
  • Phone: 570-714-5800
  • Fax: 570-714-0473
Mailing address:
  • Phone: 570-714-5800
  • Fax: 570-714-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberTP000953B
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL FULLER
Title or Position: OWNER
Credential: CRNP
Phone: 570-714-5880