Provider Demographics
NPI:1902624869
Name:PINE RUN MENTAL HEALTH & WELLNESS
Entity type:Organization
Organization Name:PINE RUN MENTAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:570-929-2277
Mailing Address - Street 1:2319 PINE RUN RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:PA
Mailing Address - Zip Code:17744-8149
Mailing Address - Country:US
Mailing Address - Phone:929-724-2277
Mailing Address - Fax:929-724-2277
Practice Address - Street 1:400 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6344
Practice Address - Country:US
Practice Address - Phone:929-724-2277
Practice Address - Fax:929-724-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty