Provider Demographics
NPI:1427751411
Name:RUPERT, NINA MARIE (PHDHP)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:MARIE
Last Name:RUPERT
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:MARIE
Other - Last Name:LENHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:557 BUCKHILL RD.
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756
Mailing Address - Country:US
Mailing Address - Phone:570-916-1143
Mailing Address - Fax:
Practice Address - Street 1:217 KING STREET
Practice Address - Street 2:
Practice Address - City:LAPERTE
Practice Address - State:PA
Practice Address - Zip Code:18626
Practice Address - Country:US
Practice Address - Phone:570-946-4363
Practice Address - Fax:570-946-4845
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH0002181223D0001X
PADH-013595-L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No1223D0001XDental ProvidersDentistDental Public Health