Healthcare Provider Details

I. General information

NPI: 1235378704
Provider Name (Legal Business Name): STEVEN C VANDEVANDER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MARTIN AVE
EPHRATA PA
17522-1734
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-733-0311
  • Fax: 717-721-5861
Mailing address:
  • Phone: 717-851-7134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number081320
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: