MEDICARE: MRS. JOANNA ERICKA ANTONIO 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	363LC0200X	Critical Care Medicine Nurse Practitioner	SP029955	PA

General Provider Information

NPI Number	:	1598501983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANNA ERICKA ANTONIO MYERS CRNP

Provider Business Mailing Address
First Line	:	218 GREGORY DR
Second Line	:
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-9002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-0001
Country	:	US
Telephone Number	:	574-271-6211
Fax Number	:

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

Provider Enumeration Date	:	07/04/2024
Last Update Date	:	07/12/2024

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