Provider Demographics
NPI:1033919097
Name:PENNSYLVANIA WESTERN UNIVERSITY
Entity type:Organization
Organization Name:PENNSYLVANIA WESTERN UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:KUNDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-297-8220
Mailing Address - Street 1:1008 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8676
Mailing Address - Country:US
Mailing Address - Phone:814-297-8220
Mailing Address - Fax:814-297-8381
Practice Address - Street 1:1008 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8676
Practice Address - Country:US
Practice Address - Phone:814-297-8220
Practice Address - Fax:814-297-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty