Provider Demographics
NPI:1891985586
Name:CRAVEN, NICOLE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SERWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:239 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3005
Mailing Address - Country:US
Mailing Address - Phone:570-421-3872
Mailing Address - Fax:570-421-8345
Practice Address - Street 1:1078 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3812
Practice Address - Country:US
Practice Address - Phone:570-241-0500
Practice Address - Fax:570-491-8012
Is Sole Proprietor?:No
Enumeration Date:2007-07-28
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
115272ECNMedicare PIN