Provider Demographics
NPI:1629679139
Name:PROFESSIONAL NURSING ASSOCIATES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL NURSING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATENGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-966-2676
Mailing Address - Street 1:1971 BROOKE CT
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-4108
Mailing Address - Country:US
Mailing Address - Phone:201-456-1366
Mailing Address - Fax:
Practice Address - Street 1:1971 BROOKE CT
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-4108
Practice Address - Country:US
Practice Address - Phone:201-456-1366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health