Healthcare Provider Details

I. General information

NPI: 1710941067
Provider Name (Legal Business Name): JOAN KROELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 PARK AVENUE EXTENSION
CLEARFIELD PA
16830
US

IV. Provider business mailing address

1036 PARK AVENUE EXTENSION
CLEARFIELD PA
16830
US

V. Phone/Fax

Practice location:
  • Phone: 814-765-9677
  • Fax: 814-765-9514
Mailing address:
  • Phone: 814-765-9677
  • Fax: 814-765-9514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP002033G
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN181910L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: