Organization
LIFE MALE SCIENCE TECHNOLOGY ENGINEERING ARTS AND MATH ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRYL CANADY PHD (CHIEF FINANCIAL OFFICER)
(252) 266-1111
Entity
Organization
Contact information
Practice address
777 PENN CENTER BLVD, PENN HILLS, PA 15235-5927
(412) 745-5433
Mailing address
11888 PALOMINO CT, NORTH HUNTINGDON, PA 15642-6712
(252) 266-1111
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
363LS0200X
School Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750548665
—
RI
05
—
1912070988
—
PA
Enumeration date
12/15/2021
Last updated
01/08/2022
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