Healthcare Provider Details

I. General information

NPI: 1750326708
Provider Name (Legal Business Name): NANCY KOBERLEIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2872 TURNPIKE STREET
SUSQUEHANNA PA
18847-2771
US

IV. Provider business mailing address

2872 TURNPIKE STREET
SUSQUEHANNA PA
18847-2771
US

V. Phone/Fax

Practice location:
  • Phone: 570-853-3135
  • Fax: 570-853-3008
Mailing address:
  • Phone: 570-853-3135
  • Fax: 570-853-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberMK1001522
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP000320B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: