Basic Information
Provider Information
NPI: 1093186926
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HWANG
FirstName: PAULINE
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 858
Address2: MC A410
City: HERSHEY
State: PA
PostalCode: 170330858
CountryCode: US
TelephoneNumber: 8002431455
FaxNumber:  
Practice Location
Address1: 2005 TECHNOLOGY PKWY STE 400
Address2:  
City: MECHANICSBURG
State: PA
PostalCode: 170509413
CountryCode: US
TelephoneNumber: 7177912520
FaxNumber: 7177030061
Other Information
ProviderEnumerationDate: 10/19/2015
LastUpdateDate: 04/04/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/04/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN648435PAN Nursing Service ProvidersRegistered Nurse 
363LA2200XSP015624PAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
363LG0600XSP015624PAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
363L00000XSP015624PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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