Healthcare Provider Details

I. General information

NPI: 1245775774
Provider Name (Legal Business Name): ALLEGHENY HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 KELLY BLVD
SLIPPERY ROCK PA
16057-8523
US

IV. Provider business mailing address

621 KELLY BLVD PO BOX 143
SLIPPERY ROCK PA
16057-8523
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-4009
  • Fax: 724-794-4099
Mailing address:
  • Phone: 724-774-4009
  • Fax: 724-794-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016893
License Number StatePA

VIII. Authorized Official

Name: LUCINDA YEAGER
Title or Position: OFFICE MANAGER
Credential:
Phone: 724-794-4009