Healthcare Provider Details

I. General information

NPI: 1780069849
Provider Name (Legal Business Name): SHERRY GOERTZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WALKER RD
CHAMBERSBURG PA
17202-9750
US

IV. Provider business mailing address

900 WALKER RD
CHAMBERSBURG PA
17202-9750
US

V. Phone/Fax

Practice location:
  • Phone: 717-360-1007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS000217
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN301666L
License Number StatePA

VIII. Authorized Official

Name: SHERRY GOERTZ
Title or Position: OWNER
Credential: PHD, PMHCNS,BC
Phone: 717-360-1007