Healthcare Provider Details

I. General information

NPI: 1730143710
Provider Name (Legal Business Name): TRACY SHERMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MARTIN AVE
EPHRATA PA
17522-1734
US

IV. Provider business mailing address

555 N DUKE ST
LANCASTER PA
17602-2250
US

V. Phone/Fax

Practice location:
  • Phone: 717-733-0311
  • Fax:
Mailing address:
  • Phone: 717-544-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN286256L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: