Provider Demographics
NPI:1043373483
Name:NEVARRE, DAVID R (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:NEVARRE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NEVARRE ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERHILL
Mailing Address - State:PA
Mailing Address - Zip Code:15958-3308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 NAPOLEON PL
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2504
Practice Address - Country:US
Practice Address - Phone:814-536-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002508L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical