Healthcare Provider Details

I. General information

NPI: 1134450661
Provider Name (Legal Business Name): ELIZABETH CHURCH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 LINCOLN HWY
GAP PA
17527-9427
US

IV. Provider business mailing address

5275 LINCOLN HWY
GAP PA
17527-9427
US

V. Phone/Fax

Practice location:
  • Phone: 717-442-8111
  • Fax: 717-442-8981
Mailing address:
  • Phone: 717-442-8111
  • Fax: 717-442-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN281307L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: