Provider Demographics
NPI:1114675956
Name:LABELLE, MARY CHRISTA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTA
Last Name:LABELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9219
Mailing Address - Country:US
Mailing Address - Phone:570-586-6203
Mailing Address - Fax:
Practice Address - Street 1:125 MILLER RD
Practice Address - Street 2:
Practice Address - City:WAVERLY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9219
Practice Address - Country:US
Practice Address - Phone:570-586-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN283050L163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management