Basic Information
| Provider Information | |||||||||
| NPI: | 1275735409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186431930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706555606 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 E END BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187110030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708243521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KEEZER | ||||||||
| AuthorizedOfficialFirstName: | SHEILA | ||||||||
| AuthorizedOfficialMiddleName: | ERICA | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED NURSE MHICM | ||||||||
| AuthorizedOfficialTelephone: | 5706555606 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.