Healthcare Provider Details

I. General information

NPI: 1013266105
Provider Name (Legal Business Name): BRIAN WEBSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 HEPBURN ST
WILLIAMSPORT PA
17701-6122
US

IV. Provider business mailing address

471 HEPBURN ST
WILLIAMSPORT PA
17701-6122
US

V. Phone/Fax

Practice location:
  • Phone: 570-567-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012317
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: