Individual
PATRICIA WALLACE BELANCIO
Active
Individual
PATRICIA WALLACE BELANCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP011629
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100727800
MEDICAID TPI GROUP
PA
01
—
597586
MEDICARE TPI GROUP
PA
01
—
CD4829
RAILROAD MEDICARE TPI GROUP
PA
Enumeration date
06/08/2012
Last updated
06/08/2012
Update your record
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