Provider Demographics
NPI:1003168162
Name:CALIFORNIA UNIVERSITY OF PENNSYLVANIA
Entity Type:Organization
Organization Name:CALIFORNIA UNIVERSITY OF PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:DUDA
Authorized Official - Last Name:FAYISH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:724-938-5922
Mailing Address - Street 1:250 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:PA
Mailing Address - Zip Code:15419-1341
Mailing Address - Country:US
Mailing Address - Phone:724-938-5922
Mailing Address - Fax:724-938-4509
Practice Address - Street 1:250 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1341
Practice Address - Country:US
Practice Address - Phone:724-938-5922
Practice Address - Fax:724-938-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006076B261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service