Provider Demographics
NPI:1174924690
Name:BATES, CARA ELIZABETH (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:ELIZABETH
Last Name:BATES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:ELIZABETH
Other - Last Name:PETRUZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1 TAMAQUA BLVD
Mailing Address - Street 2:PRYSMIAN EMPLOYEE HEALTH CLINIC
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972
Mailing Address - Country:US
Mailing Address - Phone:570-385-9216
Mailing Address - Fax:570-385-1261
Practice Address - Street 1:1 TAMAQUA BLVD
Practice Address - Street 2:PRYSMIAN EMPLOYEE HEALTH CLINIC
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972
Practice Address - Country:US
Practice Address - Phone:570-385-9216
Practice Address - Fax:570-385-1261
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014357/RN616112363LA2200X
PARN616112163W00000X
PASP014357363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology