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General NPI Number Information
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NPI Number | 1104899541
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Entity Type | Individual
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Provider Name | LISA DUVALL
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Gender | Female
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 227 HOSPITAL DR SUITE 1
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City | EVERETT
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State | PA
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Zip | 15537-7019
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Country | US
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Telephone | 814-623-9095
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Fax |
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Provider Business Mailing Address
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Address Line | 227 HOSPITAL DR SUITE 1
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City | EVERETT
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State | PA
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Zip | 15537-7019
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OS010157L
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License Number State | PA
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