Provider Demographics
NPI:1083604201
Name:GOLDSMITH, ALVERDA (CRNP)
Entity Type:Individual
Prefix:
First Name:ALVERDA
Middle Name:
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-3044
Mailing Address - Country:US
Mailing Address - Phone:814-837-7944
Mailing Address - Fax:
Practice Address - Street 1:ERPG PLATT FAMILY PRACTICE
Practice Address - Street 2:121 EAST ARCH STREET
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857
Practice Address - Country:US
Practice Address - Phone:814-834-2850
Practice Address - Fax:814-781-1580
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP000587C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA022939Medicare ID - Type Unspecified
PAS70415Medicare UPIN