Provider Demographics
NPI:1942693254
Name:THE RIVER PRACTICE
Entity Type:Organization
Organization Name:THE RIVER PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:814-270-0733
Mailing Address - Street 1:220 PINE ST
Mailing Address - Street 2:
Mailing Address - City:DAVIDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15928-8315
Mailing Address - Country:US
Mailing Address - Phone:814-270-0733
Mailing Address - Fax:
Practice Address - Street 1:3135 NEW GERMANY RD STE 24
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4347
Practice Address - Country:US
Practice Address - Phone:814-418-7759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005712B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1922218262OtherINDIVIDUAL NURSE PRACTITIONER NPI NUMBER