Provider Demographics
NPI:1598748022
Name:NEISWONGER, MICHAEL C (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:NEISWONGER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-756-2940
Mailing Address - Fax:724-756-8515
Practice Address - Street 1:296 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PETROLIA
Practice Address - State:PA
Practice Address - Zip Code:16050
Practice Address - Country:US
Practice Address - Phone:724-756-2940
Practice Address - Fax:724-756-8515
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008188363LF0000X
PARN507498L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ34382Medicare UPIN
PA087617RN0Medicare PIN