MEDICARE: NEPA HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1033501929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPA HEALTHCARE

Provider Business Mailing Address
First Line	:	400 DUNMORE ST
Second Line	:
City	:	THROOP
State	:	PA
Zip	:	18512-1147
Country	:	US
Telephone Number	:	570-489-2101
Fax Number	:	570-489-7227

Provider Business Practice Location Address
First Line	:	400 DUNMORE ST
Second Line	:
City	:	THROOP
State	:	PA
Zip	:	18512-1147
Country	:	US
Telephone Number	:	570-489-2101
Fax Number	:	570-489-7227

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JASON JEFFREY HANYON
Credential	:
Telephone Number	:	570-876-4488

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/02/2015

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Directions to “NEPA HEALTHCARE ” Practice Location

Language	Start Address	Practice Location

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