Basic Information
| Provider Information | |||||||||
| NPI: | 1568691954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEHLENBACHER | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2060 N PEARL ST | ||||||||
| Address2: | SUITE H | ||||||||
| City: | NORTH EAST | ||||||||
| State: | PA | ||||||||
| PostalCode: | 164281926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777711 | ||||||||
| FaxNumber: | 8148777715 | ||||||||
| Practice Location | |||||||||
| Address1: | 2060 N PEARL ST | ||||||||
| Address2: | SUITE H | ||||||||
| City: | NORTH EAST | ||||||||
| State: | PA | ||||||||
| PostalCode: | 164281926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777711 | ||||||||
| FaxNumber: | 8148777715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2009 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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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 | 207Q00000X | 34010489 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS015887 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.