Individual
MS. ROSANNA PATRICIA SUPPA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MA CCCLA
Contact information
Practice address
111 ELWYN RD, STE B1 YAGO BUILDING, ELWYN, PA 19063-4622
(610) 891-2216
(610) 891-7000
Mailing address
111 ELWYN RD, STE B1 YAGO BUILDING, ELWYN, PA 19063-4622
(610) 891-2216
(610) 891-7000
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AT000016L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01650369
—
PA
01
—
0486041000
KEYSTONE HEALTH PLAN EAST
PA
01
—
1030923
KEYSTONE MERCY
PA
Enumeration date
05/05/2006
Last updated
07/08/2007
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