Healthcare Provider Details

I. General information

NPI: 1659821288
Provider Name (Legal Business Name): HALLIE DEARDORFF CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALLIE AMBER KOCIEMBA CRNP

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W BROADWAY
GETTYSBURG PA
17325-1200
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-337-4105
  • Fax: 717-798-3407
Mailing address:
  • Phone: 717-646-4201
  • Fax: 717-646-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN652053
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016731
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: