Provider Demographics
NPI:1609966472
Name:MANNION, MARGUERITE D (CRNP)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:D
Last Name:MANNION
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:MANNION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:5 MORGAN HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2641
Mailing Address - Country:US
Mailing Address - Phone:570-558-7410
Mailing Address - Fax:570-207-4287
Practice Address - Street 1:5 MORGAN HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2641
Practice Address - Country:US
Practice Address - Phone:570-558-7410
Practice Address - Fax:570-207-4287
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004525B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA033682Medicare ID - Type Unspecified