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General NPI Number Information
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NPI Number | 1285858928
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Entity Type | Individual
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Provider Name | KRISTIE MARIE ANZULAVICH CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3 HOSPITAL DR SUITE 202
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City | LEWISBURG
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State | PA
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Zip | 17837-9362
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Country | US
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Telephone | 570-522-4279
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Fax | 570-522-2193
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Provider Business Mailing Address
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Address Line | 805 ELM ST
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City | WATSONTOWN
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State | PA
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Zip | 17777-1407
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Country | US
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Telephone | 570-538-4381
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Fax | 570-538-4381
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP009132
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License Number State | PA
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