Individual
MR. KEVIN JOHN WANSOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
30 MEDICAL CENTER BLVD SUITE 303, CLINICAL RENAL ASSOCIATES LTD, UPLAND, PA 19013-3995
(610) 872-8501
(610) 872-5188
Mailing address
30 MEDICAL CENTER BLVD SUITE 303, CLINICAL RENAL ASSOCIATES LTD, UPLAND, PA 19013-3995
(610) 872-8501
(610) 872-5188
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA053066
PA
Other
Enumeration date
10/15/2007
Last updated
12/20/2013
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