Active NPI
Ise Kannebecker, CRNP
- Nurse Practitioner
- Lake Como, PA
National Provider Identifier
1790156578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- SP015305
- Practice address
- 412 Como Rd
Lake Como, PA 18437-1020 - Phone
- (570) 798-2828
- Fax
- (570) 798-2636
- NPI assigned
- Oct 19, 2015
- Last updated
- Apr 6, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | SP015305 | PA | Primary |
Addresses
Primary practice location
412 Como Rd
Lake Como, PA 18437-1020
Mailing address
601 Park St
Honesdale, PA 18431-1445
Phone (570) 253-8226
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160114000465 | PA | Order and Referring Only - Nurse Practitioner | 3173826765 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP015305 | PA | MD | Nurse Practitioner |
Interoperability endpoints
- ise.kannebecker@direct.wmchc.hie.keyhie.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680739200000",
"number": "1790156578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 PARK ST",
"city": "HONESDALE",
"state": "PA",
"postal_code": "184311445",
"telephone_number": "570-253-8226",
"fax_number": "570-253-8228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 COMO RD",
"city": "LAKE COMO",
"state": "PA",
"postal_code": "184371020",
"telephone_number": "570-798-2828",
"fax_number": "570-798-2636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANNEBECKER",
"first_name": "ISE",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-19",
"last_updated": "2023-04-06",
"certification_date": "2023-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "PA",
"license": "SP015305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Como, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.