Healthcare Provider Details

I. General information

NPI: 1255609632
Provider Name (Legal Business Name): ERICA J KISSELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N 21ST ST SUITE 102
CAMP HILL PA
17011-2223
US

IV. Provider business mailing address

3 WALNUT ST SUITE 206
LEMOYNE PA
17043-1168
US

V. Phone/Fax

Practice location:
  • Phone: 717-972-2829
  • Fax: 717-695-8722
Mailing address:
  • Phone: 717-761-0208
  • Fax: 717-761-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP011809
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: