=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669950747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY K DELHUNTY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2018
-----------------------------------------------------
Last Update Date | 01/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 6TH AVE
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16602-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-944-7383
-----------------------------------------------------
Fax | 814-944-7608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 615 6TH AVE
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16602-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-944-7383
-----------------------------------------------------
Fax | 814-944-7608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA059920
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------