Provider Demographics
NPI:1811951395
Name:REESE, MARY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:REESE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-0251
Mailing Address - Country:US
Mailing Address - Phone:814-235-3051
Mailing Address - Fax:814-359-5629
Practice Address - Street 1:550 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT GAP
Practice Address - State:PA
Practice Address - Zip Code:16823-7401
Practice Address - Country:US
Practice Address - Phone:814-359-5620
Practice Address - Fax:814-359-5629
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000413L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50055176OtherCAPITAL BLUE CROSS
PAR06147Medicare UPIN