Healthcare Provider Details

I. General information

NPI: 1467721795
Provider Name (Legal Business Name): KERRI L HAJKOWSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 QUINCY AVE # 2A
SCRANTON PA
18510-1739
US

IV. Provider business mailing address

748 QUINCY AVE # 2A
SCRANTON PA
18510-1739
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-0851
  • Fax:
Mailing address:
  • Phone: 570-961-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP011673
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: