MEDICARE: FRANCES MCGLYNN 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	163W00000X	Registered Nurse	RN204480L	PA
2	363L00000X	Nurse Practitioner	VP000548B	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4212503	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1487767430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCES MCGLYNN CRNP

Provider Business Mailing Address
First Line	:	20 WYOMING AVE
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-1528
Country	:	US
Telephone Number	:	570-881-6022
Fax Number	:	570-675-2290

Provider Business Practice Location Address
First Line	:	301 LAKE ST
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-7752
Country	:	US
Telephone Number	:	570-675-2131
Fax Number	:

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/06/2019

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