Provider Demographics
NPI:1689625352
Name:CONSERETTE, ARLENE JULIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:JULIA
Last Name:CONSERETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ARLENE
Other - Middle Name:JULIA
Other - Last Name:LEVANDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:109 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-2501
Mailing Address - Country:US
Mailing Address - Phone:570-483-4603
Mailing Address - Fax:570-319-1250
Practice Address - Street 1:109 TERRACE DR
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447
Practice Address - Country:US
Practice Address - Phone:570-483-4603
Practice Address - Fax:570-483-4603
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051823363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00373776OtherRAILROAD MEDICARE
PAP00373776OtherRAILROAD MEDICARE