Provider Demographics
NPI:1508894254
Name:GOLEMBIEWSKI, PATRICIA (CRNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GOLEMBIEWSKI
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:PO BOX 14623
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-4623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:154 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026-9510
Practice Address - Country:US
Practice Address - Phone:717-865-1143
Practice Address - Fax:717-865-1136
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007939363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP0079OtherPROFESSIONAL LICENSE
PA081188Medicare ID - Type Unspecified