Healthcare Provider Details

I. General information

NPI: 1811559552
Provider Name (Legal Business Name): LISA ANN HOSTETTER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HOPE DR STE 202-204
HERSHEY PA
17033-2008
US

IV. Provider business mailing address

2112 HARRISBURG PIKE STE 200
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8550
  • Fax: 717-531-0086
Mailing address:
  • Phone: 717-290-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019304
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: