Healthcare Provider Details

I. General information

NPI: 1881021442
Provider Name (Legal Business Name): THERESA MARGUERITE WOTRING CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA MARGUERITE DIEHL

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CRYSTAL A DR
HERSHEY PA
17033-9524
US

IV. Provider business mailing address

100 CRYSTAL A DR
HERSHEY PA
17033-9524
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax: 717-312-3182
Mailing address:
  • Phone: 800-243-1455
  • Fax: 717-312-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: