Provider Demographics
NPI:1598730483
Name:NERVIANO, JOAN (PA)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:NERVIANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 LARRY DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5761
Mailing Address - Country:US
Mailing Address - Phone:717-564-6406
Mailing Address - Fax:
Practice Address - Street 1:3601 N PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9100
Practice Address - Country:US
Practice Address - Phone:717-652-7266
Practice Address - Fax:717-652-5042
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001910L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP71403Medicare UPIN