Provider Demographics
NPI:1871133447
Name:SOSTER, GINA MARIA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIA
Last Name:SOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:SNOW SHOE
Mailing Address - State:PA
Mailing Address - Zip Code:16874-8628
Mailing Address - Country:US
Mailing Address - Phone:814-387-0243
Mailing Address - Fax:
Practice Address - Street 1:330 UNIVERSITY HEALTH SERVICES
Practice Address - Street 2:1 EISENHOUWER RD.
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-2129
Practice Address - Country:US
Practice Address - Phone:814-865-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN254671L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse