Healthcare Provider Details

I. General information

NPI: 1922435056
Provider Name (Legal Business Name): STACEY L SAXON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 RIVER AVE
WILLIAMSPORT PA
17701-3724
US

IV. Provider business mailing address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-5991
  • Fax: 570-323-6578
Mailing address:
  • Phone: 570-837-2123
  • Fax: 570-837-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056493
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: