MEDICARE: MS. CAROL ANN MYERS CRNP

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	363LF0000X	Family Nurse Practitioner	SP000100B	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	161293ZA9K	OTHER	PA	MEDICARE PTAN

General Provider Information

NPI Number	:	1265442396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL ANN MYERS CRNP

Provider Business Mailing Address
First Line	:	4570 PENNS VALLEY RD
Second Line	:	STE 1
City	:	SPRING MILLS
State	:	PA
Zip	:	16875-8500
Country	:	US
Telephone Number	:	814-422-8873
Fax Number	:	814-422-8037

Provider Business Practice Location Address
First Line	:	4570 PENNS VALLEY RD
Second Line	:	STE 1
City	:	SPRING MILLS
State	:	PA
Zip	:	16875-8500
Country	:	US
Telephone Number	:	814-422-8873
Fax Number	:	814-422-8037

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	03/20/2013

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