Provider Demographics
NPI:1366911620
Name:MISERICORDIA UNIVERSITY
Entity type:Organization
Organization Name:MISERICORDIA UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEDERO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP-BC
Authorized Official - Phone:570-674-6432
Mailing Address - Street 1:301 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-7752
Mailing Address - Country:US
Mailing Address - Phone:570-674-6432
Mailing Address - Fax:570-674-3062
Practice Address - Street 1:301 LAKE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-7752
Practice Address - Country:US
Practice Address - Phone:570-674-6432
Practice Address - Fax:570-674-3062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISERICORDIA UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-16
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty