Provider Demographics
NPI:1184409815
Name:SURANOFSKY, KAYTLYN MARIE (RN)
Entity type:Individual
Prefix:
First Name:KAYTLYN
Middle Name:MARIE
Last Name:SURANOFSKY
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 1:711 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-1356
Mailing Address - Country:US
Mailing Address - Phone:610-554-5146
Mailing Address - Fax:
Practice Address - Street 1:24 N 7TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2266
Practice Address - Country:US
Practice Address - Phone:605-554-5146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN738530163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse