Provider Demographics
NPI:1013135284
Name:WOMEN TO WOMEN
Entity Type:Organization
Organization Name:WOMEN TO WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:570-714-5880
Mailing Address - Street 1:400 3RD AVE
Mailing Address - Street 2:PARK OFFICE BUILDING 208 209
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5816
Mailing Address - Country:US
Mailing Address - Phone:570-714-5800
Mailing Address - Fax:570-714-0473
Practice Address - Street 1:400 3RD AVE
Practice Address - Street 2:PARK OFFICE BUILDING 208 209
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5816
Practice Address - Country:US
Practice Address - Phone:570-714-5800
Practice Address - Fax:570-714-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP000953B261Q00000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007767610002Medicaid
PA1007767610007Medicaid
PA1007767610004Medicaid
PA1007767610008Medicaid
PA100776761Medicaid