Provider Demographics
NPI:1851619472
Name:WALES, EMILY M (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:WALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:570-882-3007
Practice Address - Street 1:3 GUTHRIE DR
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-3696
Practice Address - Country:US
Practice Address - Phone:607-973-8000
Practice Address - Fax:570-887-6801
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP010833363LF0000X
NYF345023-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily