MEDICARE: MICHAEL C NEISWONGER 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	SP008188	PA
2	163W00000X	Registered Nurse	RN507498L	PA

General Provider Information

NPI Number	:	1598748022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C NEISWONGER CRNP

Provider Business Mailing Address
First Line	:	100 SHENANGO AVE
Second Line	:
City	:	SHARON
State	:	PA
Zip	:	16146-1503
Country	:	US
Telephone Number	:	724-526-5600
Fax Number	:	724-526-3289

Provider Business Practice Location Address
First Line	:	419 KELLYS WAY
Second Line	:
City	:	EAST BRADY
State	:	PA
Zip	:	16028-2003
Country	:	US
Telephone Number	:	724-526-5600
Fax Number	:	724-526-3289

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	11/26/2025

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