Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP020370 | PA |
NPI | 1043865512 |
---|---|
Provider Name | Kayla Marie Schreckengost |
First Address | Rochester Mills, PA 15771-7523 |
Second Address | Clearfield, PA 16830-3245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2019 |
Last Update Date | 01/08/2019 |