Basic Information
Provider Information
NPI: 1346238466
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZEPKA
FirstName: TERESA
MiddleName: A
NamePrefix: MISS
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1086 FRANKLIN ST
Address2:  
City: JOHNSTOWN
State: PA
PostalCode: 159054305
CountryCode: US
TelephoneNumber: 8144108300
FaxNumber: 8144108331
Practice Location
Address1: 1111 FRANKLIN ST
Address2: STE 410
City: JOHNSTOWN
State: PA
PostalCode: 159054342
CountryCode: US
TelephoneNumber: 8145367851
FaxNumber: 8145393649
Other Information
ProviderEnumerationDate: 10/12/2005
LastUpdateDate: 11/02/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XMA056282PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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