Healthcare Provider Details

I. General information

NPI: 1013082874
Provider Name (Legal Business Name): MICHAEL ALEXIS MEWES CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE PARK WAY
SENECA PA
16346-0802
US

IV. Provider business mailing address

PO BOX 802 ONE PARK WAY,
SENECA PA
16346-0802
US

V. Phone/Fax

Practice location:
  • Phone: 814-676-5444
  • Fax: 814-676-0342
Mailing address:
  • Phone: 814-676-5444
  • Fax: 814-676-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTP005101B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: