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Individual

LIANE MAE BACON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BSN, RN

Contact information

Practice address
1000 E MOUNTAIN DR, WILKES BARRE, PA 18711-0001
(570) 808-7300
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN512192L
PA
163WG0000X
General Practice Registered Nurse
RN512192L
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN512192L
PA

Other

Enumeration date
03/08/2023
Last updated
11/27/2023
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