Provider Demographics
NPI:1548722689
Name:PENDARVIS, CHRISTY LYNN (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYNN
Last Name:PENDARVIS
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 1:144 OLD ROUTE 8 S
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059-2024
Mailing Address - Country:US
Mailing Address - Phone:724-612-1133
Mailing Address - Fax:
Practice Address - Street 1:75 BROAD STREET 815
Practice Address - Street 2:
Practice Address - City:NEW YORK,
Practice Address - State:NY
Practice Address - Zip Code:10004-2415
Practice Address - Country:US
Practice Address - Phone:347-761-1328
Practice Address - Fax:718-732-2638
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily