Provider Demographics
NPI:1942236799
Name:PONCELET, BARBARA ANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANNE
Last Name:PONCELET
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANNE
Other - Last Name:WORCHICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN
Mailing Address - Street 1:437 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-1717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16-18 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3001
Practice Address - Country:US
Practice Address - Phone:570-628-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN551849163W00000X
PASP016450363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016255830001Medicaid