Healthcare Provider Details

I. General information

NPI: 1760490346
Provider Name (Legal Business Name): JANE A WEBER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GIBNER RD
CARLISLE BARRACKS PA
17013
US

IV. Provider business mailing address

1542 INVERNESS DR
MECHANICSBURG PA
17050-8328
US

V. Phone/Fax

Practice location:
  • Phone: 717-245-4774
  • Fax: 717-245-3776
Mailing address:
  • Phone: 717-580-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP003597B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: