Basic Information
| Provider Information | |||||||||
| NPI: | 1457577090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | MARYBETH | ||||||||
| MiddleName: | THERESA | ||||||||
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| Credential: | L.P.N | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 4 BOX 4482 | ||||||||
| Address2: | |||||||||
| City: | MOSCOW | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184449221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708423622 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2250 HICKORY RD | ||||||||
| Address2: | SUITE240 | ||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108341122 | ||||||||
| FaxNumber: | 6108347525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | PN-152127-L | PA | Y | Agencies | Nursing Care |
No ID Information.