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Organization
ANNVILLE FAMILY MEDICINE, PC
Active
Organization
ANNVILLE FAMILY MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VELMA A NICKLISS (OFFICE MANAGER)
(717) 867-4671
Entity
Organization
Contact information
Practice address
475 N WEABER ST, ANNVILLE, PA 17003-1104
(717) 867-4671
Mailing address
475 N WEABER ST, ANNVILLE, PA 17003-1104
(717) 867-4671
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100935901
—
PA
Enumeration date
01/16/2006
Last updated
12/03/2009
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