Provider Demographics
NPI:1184602435
Name:KRANEK, NANCY L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:KRANEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 FIELD CIRCLE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2315
Mailing Address - Country:US
Mailing Address - Phone:330-798-9519
Mailing Address - Fax:
Practice Address - Street 1:230 QUADRAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8376
Practice Address - Country:US
Practice Address - Phone:330-336-2800
Practice Address - Fax:330-336-5325
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA112832Medicare ID - Type Unspecified