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General NPI Number Information
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NPI Number | 1164794426
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Entity Type | Individual
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Provider Name | VANESSA LEE PASCH C.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 208 KEVIN LN SUITE 101
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-7044
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Country | US
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Telephone | 570-992-7620
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 783311
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City | PHILADELPHIA
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State | PA
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Zip | 19178-3311
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP011820
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License Number State | PA
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