Organization
DEMENTIA CONNECTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN G. SCANLAND CRNP GNP BC (CEO AND FOUNDER)
(570) 586-0655
Entity
Organization
Contact information
Practice address
2500 ADAMS AVE, HOLY FAMILY RESIDENCE, SCRANTON, PA 18509-1515
(570) 343-4065
(570) 343-0448
Mailing address
104 APPLE VALLEY CIR, SOUTH ABINGTON TOWNSHIP, PA 18411-9498
(570) 586-0655
(570) 586-5174
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
VP000593C
PA
363LG0600X
Gerontology Nurse Practitioner
Primary
SP010872
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1583600PABS
PA BLUE SHIELD
PA
Enumeration date
12/21/2010
Last updated
12/21/2010
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