Provider Demographics
NPI:1841440161
Name:PRISION HEALTH SERVICE
Entity type:Organization
Organization Name:PRISION HEALTH SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:LUBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-543-4769
Mailing Address - Street 1:400 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:484-680-4921
Mailing Address - Fax:
Practice Address - Street 1:400 EAST 5TH ST.
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-490-5412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty