Healthcare Provider Details

I. General information

NPI: 1730149063
Provider Name (Legal Business Name): MARIA REGINA MURNOCK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA REGINA LACOE PA

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 ADAMS AVENUE
SCRANTON PA
18503
US

IV. Provider business mailing address

RR2 BOX 2217
FACTORYVILLE PA
18419
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-6100
  • Fax: 570-342-3316
Mailing address:
  • Phone: 570-945-3404
  • Fax: 570-342-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA050653
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA050653
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: