MEDICARE: KATIE REBECCA STUMP CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC0200X	Critical Care Medicine Nurse Practitioner	SP028632	PA
2	363LG0600X	Gerontology Nurse Practitioner	SP028632	PA
3	363LA2100X	Acute Care Nurse Practitioner	SP028632	PA

General Provider Information

NPI Number	:	1538933981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE REBECCA STUMP CRNP

Provider Business Mailing Address
First Line	:	400 HOLLY DR
Second Line	:
City	:	DAUPHIN
State	:	PA
Zip	:	17018-9764
Country	:	US
Telephone Number	:	814-441-0085
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 NORTH ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-9800
Country	:	US
Telephone Number	:	570-271-6523
Fax Number	:	570-271-8056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	01/24/2024

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Directions to “ KATIE REBECCA STUMP CRNP” Practice Location

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