Healthcare Provider Details

I. General information

NPI: 1881637213
Provider Name (Legal Business Name): LEE HETRICK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 ALEXANDER SPRING RD.
CARLISLE PA
17015
US

IV. Provider business mailing address

361 ALEXANDER SPRING
CARLISLE PA
17013-7696
US

V. Phone/Fax

Practice location:
  • Phone: 717-249-1212
  • Fax:
Mailing address:
  • Phone: 717-249-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN245215L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: