Healthcare Provider Details

I. General information

NPI: 1215270400
Provider Name (Legal Business Name): KATIE ELIZABETH STEWART CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

685 GOOD DR
LANCASTER PA
17601-2426
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-6820
  • Fax: 717-531-4702
Mailing address:
  • Phone: 717-295-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP012318
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: