Individual
MIA SAGE GUY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
620 WASHINGTON ST, HUNTINGDON, PA 16652-1722
(814) 643-0309
Mailing address
132 THE MEADOWS DR, CENTRE HALL, PA 16828-9231
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
PN306202
PA
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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