Provider Demographics
NPI:1982963856
Name:PENDRAK, MEGHAN (CRNP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:PENDRAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:GRATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-1754
Mailing Address - Country:US
Mailing Address - Phone:484-884-0183
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-8111
Practice Address - Fax:610-402-1698
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily