Healthcare Provider Details

I. General information

NPI: 1699604496
Provider Name (Legal Business Name): GINA MARIA BIANCARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

918 MARTIN DR
JESSUP PA
18434-1718
US

V. Phone/Fax

Practice location:
  • Phone: 570-815-1111
  • Fax:
Mailing address:
  • Phone: 570-815-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN744847
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: