Provider Demographics
NPI:1811132038
Name:MCHALE, LAURIE ANN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANN
Last Name:MCHALE
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 1:851 COMMERCE BLVD.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519
Mailing Address - Country:US
Mailing Address - Phone:570-489-5561
Mailing Address - Fax:570-876-5300
Practice Address - Street 1:851 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:570-489-5563
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily