Healthcare Provider Details

I. General information

NPI: 1538933981
Provider Name (Legal Business Name): KATIE REBECCA STUMP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

400 HOLLY DR
DAUPHIN PA
17018-9764
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6523
  • Fax: 570-271-8056
Mailing address:
  • Phone: 814-441-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberSP028632
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP028632
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP028632
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: