Provider Demographics
NPI:1508894460
Name:PALAIKA, CAROLYN F (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:F
Last Name:PALAIKA
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 1:56 CLUB LN
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-7957
Mailing Address - Country:US
Mailing Address - Phone:724-459-5203
Mailing Address - Fax:724-459-0949
Practice Address - Street 1:56 CLUB LN
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-7957
Practice Address - Country:US
Practice Address - Phone:724-459-5203
Practice Address - Fax:724-459-0949
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP000197A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P16489Medicare UPIN
149777Medicare PIN