Provider Demographics
NPI:1912327636
Name:CREVELING, KATHLEEN M (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CREVELING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:MAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 COMMUNITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8985
Mailing Address - Country:US
Mailing Address - Phone:570-839-8754
Mailing Address - Fax:570-839-1079
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-420-4951
Practice Address - Fax:570-476-3754
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily