MEDICARE: MRS. DARLENE COVOL RN

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	RN266449L	PA
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN266449L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN266449L	OTHER	PA	LICENSE NUMBER

General Provider Information

NPI Number	:	1144642778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARLENE COVOL RN

Provider Business Mailing Address
First Line	:	2 EASTGATE AVE
Second Line	:	SUITE 102
City	:	MONESSEN
State	:	PA
Zip	:	15062-1393
Country	:	US
Telephone Number	:	724-684-6489
Fax Number	:	724-684-7116

Provider Business Practice Location Address
First Line	:	2 EASTGATE AVE
Second Line	:	SUITE 102
City	:	MONESSEN
State	:	PA
Zip	:	15062-1393
Country	:	US
Telephone Number	:	724-684-6489
Fax Number	:	724-684-7116

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

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	01/16/2014

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