Provider Demographics
NPI:1821055294
Name:ZALE REFICE, NANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANNETTE
Middle Name:
Last Name:ZALE REFICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:CREDENTIALS DEPT
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:1000 MEADE ST
Practice Address - Street 2:STE 102
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3186
Practice Address - Country:US
Practice Address - Phone:570-207-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065460L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017529210008Medicaid
PA0017529210008Medicaid
PARE087884Medicare PIN