Provider Demographics
NPI:1578717443
Name:RONCO, CRAIG ANDREW (CRNP)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ANDREW
Last Name:RONCO
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 1:18 STEEP LN
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-9602
Mailing Address - Country:US
Mailing Address - Phone:610-484-1145
Mailing Address - Fax:
Practice Address - Street 1:100 W SPROUL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2033
Practice Address - Country:US
Practice Address - Phone:610-484-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASO010010363LA2100X
PASP010010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA139258Medicare PIN