Provider Demographics
NPI:1942288238
Name:MONGERA, CHERYL A (CRNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MONGERA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 YORK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1420
Mailing Address - Country:US
Mailing Address - Phone:814-664-3979
Mailing Address - Fax:814-663-4879
Practice Address - Street 1:300 YORK ST
Practice Address - Street 2:SUITE B
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1420
Practice Address - Country:US
Practice Address - Phone:814-664-3979
Practice Address - Fax:814-663-4879
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003848B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992788012OtherORGANIZATION TAX ID/NPI
NY9511964OtherINDEPENDENT HEALTH
NY00026526801OtherUNIVERA HEALTHCARE
PAS44756Medicare UPIN
PA002000TEWMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER