Healthcare Provider Details

I. General information

NPI: 1801786520
Provider Name (Legal Business Name): THE PENN STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 TOFTREES AVE APT 212
STATE COLLEGE PA
16803-2058
US

IV. Provider business mailing address

349 TOFTREES AVE APT 212
STATE COLLEGE PA
16803-2058
US

V. Phone/Fax

Practice location:
  • Phone: 484-802-3995
  • Fax:
Mailing address:
  • Phone: 484-802-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PROF. SISTER AGNES MARIE CUMMINGS
Title or Position: ASSISTANT PROFESSOR
Credential: PH.D
Phone: 484-802-3995