Healthcare Provider Details

I. General information

NPI: 1154832509
Provider Name (Legal Business Name): ERIC WAYNE KREINBROOK CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CAMEO LN
GREENSBURG PA
15601-9230
US

IV. Provider business mailing address

5 TANGLEWOOD DR
GREENSBURG PA
15601-5811
US

V. Phone/Fax

Practice location:
  • Phone: 724-834-1326
  • Fax: 724-834-6685
Mailing address:
  • Phone: 724-689-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017669
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: