Provider Demographics
NPI:1376588186
Name:LAKOFF, CHARYL JOSEPHINE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CHARYL
Middle Name:JOSEPHINE
Last Name:LAKOFF
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 ROCKCRESS DR
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1646
Mailing Address - Country:US
Mailing Address - Phone:215-491-3373
Mailing Address - Fax:
Practice Address - Street 1:1629 ROCKCRESS DR
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1646
Practice Address - Country:US
Practice Address - Phone:215-491-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN221645L367500000X
NJ26NJ00189600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00274944OtherRAILROAD MEDICARE
PA50088071OtherCAPITAL BLUE CROSS
NJ033681RVBMedicare PIN
PA020388Q1RMedicare PIN
PA020388GDNMedicare PIN
PAP00274944OtherRAILROAD MEDICARE