Individual
LEEANN MCDERMOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
420 S JACKSON ST, POTTSVILLE, PA 17901-3625
(570) 621-5000
Mailing address
5 TRIPP MNR, FORTY FORT, PA 18704-4025
(570) 287-1558
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
RN303680L
PA
363LF0000X
Family Nurse Practitioner
Primary
SP019327
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN30368L
RN
PA
01
—
SP019327
CRNP
PA
Enumeration date
11/12/2018
Last updated
11/12/2018
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