Provider Demographics
NPI:1134245046
Name:MANTIONE, ANDREA (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MANTIONE
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E SAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2709
Mailing Address - Country:US
Mailing Address - Phone:570-824-1460
Mailing Address - Fax:
Practice Address - Street 1:800 LINDEN ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-4694
Practice Address - Country:US
Practice Address - Phone:570-941-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005805B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily