Individual
CARLI R GAYNOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
355 JEFFERSON ST, SIMPSON, PA 18407-1213
(570) 604-2838
Mailing address
242 HUDSON ST, FOREST CITY, PA 18421-1410
(570) 604-2838
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3747A0650X
—
PA
Enumeration date
11/16/2019
Last updated
11/16/2019
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