Healthcare Provider Details

I. General information

NPI: 1952302150
Provider Name (Legal Business Name): JOHN SONOGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 EDGEWOOD DRIVE EXT 7TH FLOOR
TRANSFER PA
16154-1817
US

IV. Provider business mailing address

310 LIGO RD 7TH FLOOR
MERCER PA
16137-4936
US

V. Phone/Fax

Practice location:
  • Phone: 724-646-0413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN233291L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: