Provider Demographics
NPI:1023091733
Name:MIDON, JOAN P (CRNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:P
Last Name:MIDON
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 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-704-7386
Mailing Address - Fax:724-704-7390
Practice Address - Street 1:1302 7TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4217
Practice Address - Country:US
Practice Address - Phone:724-843-4010
Practice Address - Fax:724-843-8728
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN129402L163W00000X
PASP000098A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMI007674Medicare ID - Type Unspecified
PAS54056Medicare UPIN