Provider Demographics
NPI:1235208935
Name:KELLOGG, MARGARET L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:L
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:MARGARET
Other - Middle Name:L
Other - Last Name:KELLOGG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:1860 FAIR AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-2108
Mailing Address - Country:US
Mailing Address - Phone:570-253-3391
Mailing Address - Fax:570-253-1811
Practice Address - Street 1:1860 FAIR AVE STE A
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-2108
Practice Address - Country:US
Practice Address - Phone:570-253-3391
Practice Address - Fax:570-253-1811
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP007516OtherCRNP PA LICENSE