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General NPI Number Information
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NPI Number | 1205656170
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Entity Type | Individual
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Provider Name | SHAE REA TONKOVICH
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 9707 LINCOLN HIGHWAY
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City | BEDFORD
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State | PA
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Zip | 15522-3717
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Country | US
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Telephone | 814-652-3220
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Fax |
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Provider Business Mailing Address
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Address Line | 3779 PITT ST
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City | SCHELLSBURG
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State | PA
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Zip | 15559-9040
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Country | US
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Telephone | 304-680-3411
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN795598
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License Number State | PA
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