Provider Demographics
NPI:1447463716
Name:KASHLAK, NANCY LYNN (RN,CPNP,MSN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:KASHLAK
Suffix:
Gender:F
Credentials:RN,CPNP,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MAHANOY AVE
Mailing Address - Street 2:HOMETOWN
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-4006
Mailing Address - Country:US
Mailing Address - Phone:570-668-3704
Mailing Address - Fax:
Practice Address - Street 1:1400 S 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-5919
Practice Address - Country:US
Practice Address - Phone:215-467-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000448D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics