Basic Information
Provider Information | |||||||||
NPI: | 1033537592 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KROON | ||||||||
FirstName: | CAITLIN | ||||||||
MiddleName: | E | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MACALUSO | ||||||||
OtherFirstName: | CAITLIN | ||||||||
OtherMiddleName: | E | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 858 | ||||||||
Address2: | MC A410 | ||||||||
City: | HERSHEY | ||||||||
State: | PA | ||||||||
PostalCode: | 170330858 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8002431455 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 500 UNIVERSITY DR | ||||||||
Address2: |   | ||||||||
City: | HERSHEY | ||||||||
State: | PA | ||||||||
PostalCode: | 170332360 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8002431455 | ||||||||
FaxNumber: | 7175314907 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/02/2014 | ||||||||
LastUpdateDate: | 01/29/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/29/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA056806 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 103143716 | 05 | PA |   | MEDICAID |