Healthcare Provider Details

I. General information

NPI: 1679541684
Provider Name (Legal Business Name): AIMEE LYNN GESSNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GESSNER WAY
NORTHUMBERLAND PA
17857-1535
US

IV. Provider business mailing address

5 GESSNER WAY
NORTHUMBERLAND PA
17857-1535
US

V. Phone/Fax

Practice location:
  • Phone: 570-473-7017
  • Fax: 570-473-7014
Mailing address:
  • Phone: 570-473-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051573
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051573
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: