Healthcare Provider Details

I. General information

NPI: 1487904827
Provider Name (Legal Business Name): ANGELA KLINE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 FAIR ST
BLOOMSBURG PA
17815-1419
US

IV. Provider business mailing address

100 N ACADEMY AVE # MC4903
DANVILLE PA
17822-9800
US

V. Phone/Fax

Practice location:
  • Phone: 570-387-2111
  • Fax:
Mailing address:
  • Phone: 570-271-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012805
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: