Organization
ANGELRAY FAMILY MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KRISTIN MARIE O'DONNELL MSN, CRNP (FAMILY NURSE PRACTITIONER)
(570) 590-2573
Entity
Organization
Contact information
Practice address
215 W CENTRE ST, MAHANOY CITY, PA 17948-2505
(570) 590-2573
Mailing address
215 W CENTRE ST, MAHANOY CITY, PA 17948-2505
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
SP009671
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021574590001
—
PA
01
—
1104094291
INDIVIDUAL PROVIDER NPI
PA
01
—
11974651
CAQH PROVIDER ID
PA
Enumeration date
08/19/2011
Last updated
08/19/2011
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