Provider Demographics
NPI:1295700698
Name:KRENKEL, CAROLYN LOUISE (NP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LOUISE
Last Name:KRENKEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 NUCKOLS RD 110
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9246
Mailing Address - Country:US
Mailing Address - Phone:804-396-6412
Mailing Address - Fax:
Practice Address - Street 1:5261 CARROLLTON PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3030
Practice Address - Country:US
Practice Address - Phone:276-238-8876
Practice Address - Fax:276-238-8886
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171506363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
261083931OtherTAX ID
C10361OtherGROUP ORGANIZATION PTAN
VA1295700698Medicaid
DN2980OtherGROUP PTAN
Q52983OtherPTAN
Q52983OtherPTAN
C10361OtherGROUP ORGANIZATION PTAN
DN2980OtherGROUP PTAN
TX8L6920Medicare PIN