Healthcare Provider Details

I. General information

NPI: 1720089238
Provider Name (Legal Business Name): ROSALIND C KLINEPETER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 STRAWBERRY LN
BIG COVE TANNERY PA
17212-9425
US

IV. Provider business mailing address

386 STRAWBERRY LN
BIG COVE TANNERY PA
17212-9425
US

V. Phone/Fax

Practice location:
  • Phone: 717-816-6914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN176944L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW008573L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW008573L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: