Individual
ISE KANNEBECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
412 COMO RD, LAKE COMO, PA 18437-1020
(570) 798-2828
(570) 798-2636
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
(570) 253-8226
(570) 253-8228
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP015305
PA
Other
Enumeration date
10/19/2015
Last updated
04/06/2023
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