Healthcare Provider Details

I. General information

NPI: 1144272337
Provider Name (Legal Business Name): ROSE A MEDICE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 OREGON PIKE
BROWNSTOWN PA
17508-5083
US

IV. Provider business mailing address

4131 OREGON PIKE SUITE C
EPHRATA PA
17522-9550
US

V. Phone/Fax

Practice location:
  • Phone: 717-859-1123
  • Fax: 717-859-2898
Mailing address:
  • Phone: 717-859-5161
  • Fax: 717-859-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007969
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: