Provider Demographics
NPI:1386888774
Name:COMMUNITY RESOURCE NURSE PRACTITIONERS, LLC
Entity type:Organization
Organization Name:COMMUNITY RESOURCE NURSE PRACTITIONERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLADINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-424-1235
Mailing Address - Street 1:1154A W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1323
Mailing Address - Country:US
Mailing Address - Phone:570-424-1235
Mailing Address - Fax:570-424-1259
Practice Address - Street 1:1154A W MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1323
Practice Address - Country:US
Practice Address - Phone:570-424-1235
Practice Address - Fax:570-424-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No251J00000XAgenciesNursing Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care