# FAYETTE OB/GYN

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

## Provider details

- **NPI number:** 1962823112
- **Authorized official:** SHELLEY WILSON (BILLER)
- **Authorized official phone:** (724) 430-6200

## Contact information

- **Practice address:** 404 W MAIN ST, UNIONTOWN, PA 15401-2868
- **Practice address phone:** (724) 430-6200
- **Practice address fax:** (724) 430-6250
- **Mailing address:** 404 W MAIN ST, UNIONTOWN, PA 15401-2868
- **Mailing address phone:** (724) 430-6200
- **Mailing address fax:** (724) 430-6250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WW0101X | Ambulatory Women's Health Care Registered Nurse | SP013519 | PA | Yes |

## Other

- **Enumeration date:** 12/13/2013
- **Last updated:** 12/13/2013