Healthcare Provider Details

I. General information

NPI: 1912599283
Provider Name (Legal Business Name): LYNNETTE SEFCHICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E PARK AVE
STATE COLLEGE PA
16803-6701
US

IV. Provider business mailing address

117 TRINITY LN
PORT MATILDA PA
16870-7050
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-7000
  • Fax:
Mailing address:
  • Phone: 814-777-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number565740
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: