Healthcare Provider Details

I. General information

NPI: 1598018210
Provider Name (Legal Business Name): TERESA M. CONTE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 WYOMING AVE.
SCRANTON PA
18509-3023
US

IV. Provider business mailing address

959 WYOMING AVE PO BOX 31
SCRANTON PA
18509-3023
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-9684
  • Fax: 570-969-0968
Mailing address:
  • Phone: 570-344-3517
  • Fax: 570-344-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP008177
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: