Healthcare Provider Details

I. General information

NPI: 1023688397
Provider Name (Legal Business Name): KERRY LYNN ALTLAND CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KERRY LYNN WILSON

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GOOD HOPE RD
ENOLA PA
17025-1210
US

IV. Provider business mailing address

108 E FRONT ST
LEWISBERRY PA
17339-8865
US

V. Phone/Fax

Practice location:
  • Phone: 717-981-9000
  • Fax:
Mailing address:
  • Phone: 717-542-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN703274
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP025871
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: