Provider Demographics
NPI:1992351415
Name:RENNINGER, CERA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:CERA
Middle Name:NICOLE
Last Name:RENNINGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CERA
Other - Middle Name:
Other - Last Name:BLUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-1900
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH ACADEMY AVE
Practice Address - Street 2:DANVILLE, PA 17822
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-6429
Practice Address - Fax:570-271-6854
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005524363A00000X
PAMA062121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant