Provider Demographics
NPI:1932511417
Name:CITUK, KENDRA (RN)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:CITUK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 STATE ROUTE 239
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:PA
Mailing Address - Zip Code:17814-7939
Mailing Address - Country:US
Mailing Address - Phone:484-258-4448
Mailing Address - Fax:
Practice Address - Street 1:516 STATE ROUTE 239
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:PA
Practice Address - Zip Code:17814-7939
Practice Address - Country:US
Practice Address - Phone:484-258-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN626574163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse