MEDICARE: ANN R VAYANSKY CPNP

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	363L00000X	Nurse Practitioner	UP000539D	PA

General Provider Information

NPI Number	:	1871693879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN R VAYANSKY CPNP

Provider Business Mailing Address
First Line	:	1B MAIN ST
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1601
Country	:	US
Telephone Number	:	570-724-7100
Fax Number	:	570-724-1501

Provider Business Practice Location Address
First Line	:	1B MAIN ST
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1601
Country	:	US
Telephone Number	:	570-724-7100
Fax Number	:	570-724-1501

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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