Provider Demographics
NPI:1568076511
Name:PESCATORE, RENEE (APN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:PESCATORE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 OAK LEAF LN
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:PA
Mailing Address - Zip Code:19043-1456
Mailing Address - Country:US
Mailing Address - Phone:484-680-3124
Mailing Address - Fax:
Practice Address - Street 1:1939 OAK LEAF LN
Practice Address - Street 2:
Practice Address - City:HOLMES
Practice Address - State:PA
Practice Address - Zip Code:19043-1456
Practice Address - Country:US
Practice Address - Phone:484-680-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022161363LF0000X
DELG-0011478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily