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General NPI Number Information
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NPI Number | 1235029661
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Entity Type | Individual
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Provider Name | NATHAN JARICK CRNP
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Gender | Male
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 340 MONTAGE MOUNTAIN RD
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City | MOOSIC
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State | PA
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Zip | 18507-1707
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Country | US
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Telephone | 570-346-3686
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Fax |
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Provider Business Mailing Address
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Address Line | 288 BARRYS RD
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City | WHITE HAVEN
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State | PA
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Zip | 18661-3519
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Country | US
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Telephone | 484-280-8350
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP033114
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License Number State | PA
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