MEDICARE: DR. KRISTY NETKOWICZ DO

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	207Q00000X	Family Medicine Physician	OS018799	PA

General Provider Information

NPI Number	:	1033523030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTY NETKOWICZ DO

Provider Business Mailing Address
First Line	:	2060 N PEARL ST
Second Line	:
City	:	NORTH EAST
State	:	PA
Zip	:	16428-1999
Country	:	US
Telephone Number	:	814-877-7711
Fax Number	:	814-877-7715

Provider Business Practice Location Address
First Line	:	2060 N PEARL ST
Second Line	:
City	:	NORTH EAST
State	:	PA
Zip	:	16428-1999
Country	:	US
Telephone Number	:	814-877-7711
Fax Number	:	814-877-7715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	02/15/2024

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