Provider Demographics
NPI:1699548388
Name:MERA, MCKENNA RENEE (CRNP)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:RENEE
Last Name:MERA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 ICE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-9654
Mailing Address - Country:US
Mailing Address - Phone:570-899-3646
Mailing Address - Fax:
Practice Address - Street 1:3 W OLIVE ST STE 220
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2576
Practice Address - Country:US
Practice Address - Phone:570-207-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily