Provider Demographics
NPI:1710941067
Name:KROELL, JOAN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:KROELL
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 1:1036 PARK AVENUE EXTENSION
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830
Mailing Address - Country:US
Mailing Address - Phone:814-765-9677
Mailing Address - Fax:814-765-9514
Practice Address - Street 1:1036 PARK AVENUE EXTENSION
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830
Practice Address - Country:US
Practice Address - Phone:814-765-9677
Practice Address - Fax:814-765-9514
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN181910L163W00000X
PASP002033G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1991407OtherHIGHMARK
PAKR119791OtherHIGHMARK
PAF51544Medicare UPIN
PA119791L5TMedicare PIN
PA119791L55Medicare PIN