=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841440161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRISION HEALTH SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2008
-----------------------------------------------------
Last Update Date | 09/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 EAST 5TH ST.
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-490-5412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 E 5TH ST
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-680-4921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CERTIFIED FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | REGINA V LUBERTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-543-4769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP007623
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------