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General NPI Number Information
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NPI Number | 1215878574
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Entity Type | Individual
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Provider Name | GERALDINE A KOZUCH-MCANDREW CHW
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Gender | Female
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 5 S WASHINGTON AVE
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City | JERMYN
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State | PA
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Zip | 18433-1121
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Country | US
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Telephone | 570-267-4199
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Fax |
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Provider Business Mailing Address
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Address Line | 420 DEPEW AVE
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City | MAYFIELD
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State | PA
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Zip | 18433-1708
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Country | US
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Telephone | 570-267-4199
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | PA
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