Individual
HOLLY MARIE DRUTAROVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-0027
(570) 808-7300
Mailing address
100 NORTH ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
MA060011
PA
2084N0400X
Neurology Physician
OA004573
PA
363A00000X
Physician Assistant
Primary
MA060011
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA060011
PENNSYLVANIA STATE BOARD OF MEDICINE LICENSE
PA
01
—
OA004573
PENNSYLVANIA STATE BOARD OF OSTEOPATHIC MEDICINE LICENSE
PA
Enumeration date
08/14/2018
Last updated
08/31/2020
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