Healthcare Provider Details

I. General information

NPI: 1023479615
Provider Name (Legal Business Name): JEREMY SCOTT CUMMINGS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EVERGREENE DR
WAYNESBURG PA
15370-6000
US

IV. Provider business mailing address

592 BRADDOCK AVE
UNIONTOWN PA
15401-5402
US

V. Phone/Fax

Practice location:
  • Phone: 724-852-2273
  • Fax:
Mailing address:
  • Phone: 724-322-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN602587
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: