Healthcare Provider Details

I. General information

NPI: 1740839273
Provider Name (Legal Business Name): THERESA GERMANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2019
Last Update Date: 09/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SMALLACOMBE DR
SCRANTON PA
18508-2616
US

IV. Provider business mailing address

400 HUDSON ST
MAYFIELD PA
18433-2118
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-0171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020631
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: