Healthcare Provider Details

I. General information

NPI: 1891191417
Provider Name (Legal Business Name): STACY HITTNER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PARK DR STE 101
HARRISBURG PA
17110-9303
US

IV. Provider business mailing address

2500 BERNVILLE RD
READING PA
19605-9453
US

V. Phone/Fax

Practice location:
  • Phone: 717-686-9842
  • Fax:
Mailing address:
  • Phone: 610-378-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014563
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: