Provider Demographics
NPI:1659477230
Name:ROSENCRANS, JOHN W (NP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:ROSENCRANS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5118
Mailing Address - Country:US
Mailing Address - Phone:570-288-1258
Mailing Address - Fax:570-714-7851
Practice Address - Street 1:200 2ND AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5722
Practice Address - Country:US
Practice Address - Phone:570-288-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005021B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00185871OtherRR MEDICARE
PAR01561461OtherBLUE SHIELD
PA078322TNAMedicare ID - Type Unspecified
PAR01561461OtherBLUE SHIELD
PA078322TM9Medicare ID - Type Unspecified
PAP00185871OtherRR MEDICARE