Provider Demographics
NPI:1316924335
Name:RHOA, MARYELLEN (CRNP)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:RHOA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:CRUM RHOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:1000 PARK PLACE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5946
Mailing Address - Country:US
Mailing Address - Phone:724-229-7570
Mailing Address - Fax:724-229-7571
Practice Address - Street 1:1000 PARK PLACE
Practice Address - Street 2:SUITE 209
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5946
Practice Address - Country:US
Practice Address - Phone:724-229-7570
Practice Address - Fax:724-229-7571
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004243B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875375OtherMEDICARE GROUP NUMBER
PA500028008OtherRAILROAD MEDICARE-VB
PA500028008OtherRAILROAD MEDICARE-VB