Michelle L Gauntlett, PA-C
Physician Assistant, Medical in Old Forge, PA. Individual provider (NPI-1).
NPI number1487908950
StatusActive
Last updated in NPPESJan 7, 2022
Details
- NPI
- 1487908950
- Entity type
- Individual (NPI-1)
- Name
- Michelle L Gauntlett
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 5, 2012
- Certification date
- Jan 7, 2022
- Last updated
- Jan 7, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | OA001000 | PA | Yes |
Practice location
821 S Main StSuite3
Old Forge, PA 18518-1497
Phone 570-457-0562 · Fax 570-457-0603
Mailing address
650 Main StAvoca, PA 18641-1518
Phone 570-471-3352 · Fax 570-471-7873
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