Provider Demographics
NPI:1891770848
Name:KRAFTY, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KRAFTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST STE 401
Mailing Address - Street 2:4TH FLOOR, SUITE 401
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST STE 401
Practice Address - Street 2:4TH FLOOR, SUITE 401
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1438
Practice Address - Country:US
Practice Address - Phone:814-877-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner