Basic Information
Provider Information
NPI: 1003057001
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAKALECZ
FirstName: JANEANN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1824 GOOD HOPE RD
Address2:  
City: ENOLA
State: PA
PostalCode: 170251233
CountryCode: US
TelephoneNumber: 7179889015
FaxNumber: 7172215410
Practice Location
Address1: 1824 GOOD HOPE RD
Address2:  
City: ENOLA
State: PA
PostalCode: 170251233
CountryCode: US
TelephoneNumber: 7179889015
FaxNumber: 7172215410
Other Information
ProviderEnumerationDate: 03/20/2009
LastUpdateDate: 01/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
176B00000X  N Other Service ProvidersMidwife 
367A00000XMW010194PAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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