Individual
MS. MARY ELAINE SOUTHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2222 WEBSTER AVE., SCRANTON, PA 18505
(570) 604-2994
(570) 647-7604
Mailing address
2222 S WEBSTER AVE., SCRANTON, PA 18505
(570) 604-2994
(570) 347-7604
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN2205411
PA
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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