Provider Demographics
NPI:1801435409
Name:EL-ATTRACHE, SAMRA (CRNP)
Entity type:Individual
Prefix:
First Name:SAMRA
Middle Name:
Last Name:EL-ATTRACHE
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 1:790 MULBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-3586
Mailing Address - Country:US
Mailing Address - Phone:724-547-3576
Mailing Address - Fax:724-547-0242
Practice Address - Street 1:20 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-2094
Practice Address - Country:US
Practice Address - Phone:724-547-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019830363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP019830OtherLISCENSE