Provider Demographics
NPI:1811531767
Name:CERANKOWSKI, KACEYANNE LYNN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KACEYANNE
Middle Name:LYNN
Last Name:CERANKOWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-5902
Mailing Address - Country:US
Mailing Address - Phone:267-230-6649
Mailing Address - Fax:
Practice Address - Street 1:3131 PRINCETON PIKE BLDG 4A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00549600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty