Basic Information
| Provider Information | |||||||||
| NPI: | 1649694894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEST | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | GULLO | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1930 BLACK RIVER RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180158919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108679919 | ||||||||
| FaxNumber: | 6102822091 | ||||||||
| Practice Location | |||||||||
| Address1: | 7248 TILGHMAN ST | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181069355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103368000 | ||||||||
| FaxNumber: | 6103366082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2014 | ||||||||
| LastUpdateDate: | 02/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | UP000891C2 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.