Basic Information
| Provider Information | |||||||||
| NPI: | 1215045372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEHRLI NOVAKOSKI | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 717 STATE ST | ||||||||
| Address2: | SUITE 16 LL | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165011341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144807100 | ||||||||
| FaxNumber: | 8144807604 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 STATE STREET | ||||||||
| Address2: | STE 302 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148775700 | ||||||||
| FaxNumber: | 8148775655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 05/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA051499 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 02822457 | 01 | NY | NY MEDICAL ASSISTANCE | OTHER | P00375056 | 01 | PA | RR MEDICARE | OTHER | 00026532402 | 01 | NY | UNIVERA | OTHER | P00090109 | 01 | PA | RR MEDICARE | OTHER |