Individual
MICHELLE L GAUNTLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
821 S MAIN ST, SUITE3, OLD FORGE, PA 18518-1497
(570) 457-0562
(570) 457-0603
Mailing address
650 MAIN ST, AVOCA, PA 18641-1518
(570) 471-3352
(570) 471-7873
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
OA001000
PA
Other
Enumeration date
11/05/2012
Last updated
01/07/2022
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