Basic Information
| Provider Information | |||||||||
| NPI: | 1912327636 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREVELING | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAGER | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 COMMUNITY DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | TOBYHANNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184668985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708398754 | ||||||||
| FaxNumber: | 5708391079 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 E BROWN ST | ||||||||
| Address2: | |||||||||
| City: | EAST STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183013006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704204951 | ||||||||
| FaxNumber: | 5704763754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 04/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP012643 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.