Provider Demographics
NPI:1043654197
Name:KASPRZAK, DAVID B (CRNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:KASPRZAK
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W WHITE BEAR DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18250-1728
Mailing Address - Country:US
Mailing Address - Phone:570-657-1634
Mailing Address - Fax:
Practice Address - Street 1:229 W BROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1818
Practice Address - Country:US
Practice Address - Phone:570-657-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025725363LF0000X
PARN289685L163WU0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WU0100XNursing Service ProvidersRegistered NurseUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP025725OtherCRNP