1619215894 NPI number — EMMA LYNNE KRAYNAK PA-C

Table of content: EMMA LYNNE KRAYNAK PA-C (NPI 1619215894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619215894 NPI number — EMMA LYNNE KRAYNAK PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAYNAK
Provider First Name:
EMMA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619215894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 CHERRY TREE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401-8947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-438-4364
Provider Business Mailing Address Fax Number:
724-438-4720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 CHERRY TREE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-438-4364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  MA055966 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1033558520003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".