# ANNVILLE FAMILY MEDICINE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477532653
- **Authorized official:** VELMA A NICKLISS (OFFICE MANAGER)
- **Authorized official phone:** (717) 867-4671

## Contact information

- **Practice address:** 475 N WEABER ST, ANNVILLE, PA 17003-1104
- **Practice address phone:** (717) 867-4671
- **Mailing address:** 475 N WEABER ST, ANNVILLE, PA 17003-1104
- **Mailing address phone:** (717) 867-4671

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/16/2006
- **Last updated:** 12/03/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100935901 | — | PA |