Provider Demographics
NPI:1861740714
Name:MABIE, LUANN (CRNP)
Entity type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:MABIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-6200
Mailing Address - Fax:814-375-6202
Practice Address - Street 1:1200 WOOD ST
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:PA
Practice Address - Zip Code:15824-2118
Practice Address - Country:US
Practice Address - Phone:814-265-8636
Practice Address - Fax:814-265-8536
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner