Provider Demographics
NPI:1396587879
Name:KLINK, ANNA MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:KLINK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:DEROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10225 BULLIS RD
Mailing Address - Street 2:
Mailing Address - City:LINESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16424-5335
Mailing Address - Country:US
Mailing Address - Phone:814-807-8437
Mailing Address - Fax:
Practice Address - Street 1:751 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2591
Practice Address - Country:US
Practice Address - Phone:814-333-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily