Basic Information
| Provider Information | |||||||||
| NPI: | 1548722689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENDARVIS | ||||||||
| FirstName: | CHRISTY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 144 OLD ROUTE 8 S | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160592024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246121133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 BROAD STREET 815 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK, | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100042415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477611328 | ||||||||
| FaxNumber: | 7187322638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2019 | ||||||||
| LastUpdateDate: | 04/05/2019 | ||||||||
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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 | 363LF0000X | SP015257 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.