Healthcare Provider Details

I. General information

NPI: 1982249512
Provider Name (Legal Business Name): ALEXIS LYNN HENRY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 CHAMBERS HILL RD
HARRISBURG PA
17111-2545
US

IV. Provider business mailing address

409 S 2ND ST STE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-564-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP021100
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: