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General NPI Number Information
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NPI Number | 1407336993
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Entity Type | Individual
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Provider Name | MINDY VLACICH CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 100 N ACADEMY AVE
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City | DANVILLE
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State | PA
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Zip | 17822-3198
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Country | US
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Telephone | 570-271-6028
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Fax | 570-271-5845
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Provider Business Mailing Address
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Address Line | 100 N ACADEMY AVE
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City | DANVILLE
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State | PA
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Zip | 17822-4903
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Country | US
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Telephone | 570-271-6144
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Fax | 570-271-6578
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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 | RN565857
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP019175
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License Number State | PA
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