Provider Demographics
NPI:1215045372
Name:KEHRLI NOVAKOSKI, ANNE ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:KEHRLI NOVAKOSKI
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:717 STATE ST
Mailing Address - Street 2:SUITE 16 LL
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1341
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:300 STATE STREET
Practice Address - Street 2:STE 302
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-877-5700
Practice Address - Fax:814-877-5655
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA051499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02822457OtherNY MEDICAL ASSISTANCE
PAP00375056OtherRR MEDICARE
NY00026532402OtherUNIVERA
PAP00090109OtherRR MEDICARE
PAP00375056OtherRR MEDICARE
PA075067E7CMedicare UPIN