Basic Information
| Provider Information | |||||||||
| NPI: | 1497131064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEL BIONDO | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GIFFORD | ||||||||
| OtherFirstName: | TERRY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 409 S 2ND ST STE 2F | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176371738 | ||||||||
| FaxNumber: | 7176467430 | ||||||||
| Practice Location | |||||||||
| Address1: | 1703 INNOVATION DR STE 4120 | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174088815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178495576 | ||||||||
| FaxNumber: | 7178495596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2015 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP015128 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.