MEDICARE: MARYELLEN RHOA 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	TP004243B	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	875375	OTHER	PA	MEDICARE GROUP NUMBER
2	500028008	OTHER	PA	RAILROAD MEDICARE-VB

General Provider Information

NPI Number	:	1316924335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYELLEN RHOA CRNP

Provider Business Mailing Address
First Line	:	1000 PARK PLACE
Second Line	:	SUITE 209
City	:	WASHINGTON
State	:	PA
Zip	:	15301-5946
Country	:	US
Telephone Number	:	724-229-7570
Fax Number	:	724-229-7571

Provider Business Practice Location Address
First Line	:	1000 PARK PLACE
Second Line	:	SUITE 209
City	:	WASHINGTON
State	:	PA
Zip	:	15301-5946
Country	:	US
Telephone Number	:	724-229-7570
Fax Number	:	724-229-7571

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	06/09/2016

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