Healthcare Provider Details

I. General information

NPI: 1528169257
Provider Name (Legal Business Name): PAUL LOGAN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ST PAUL DR STE 201
CHAMBERSBURG PA
17201-1036
US

IV. Provider business mailing address

785 5TH AVE STE 3
CHAMBERSBURG PA
17201-4232
US

V. Phone/Fax

Practice location:
  • Phone: 717-217-6944
  • Fax: 717-217-6955
Mailing address:
  • Phone: 717-263-9555
  • Fax: 717-709-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP003104P
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberTP003104P
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN316830L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: