Healthcare Provider Details

I. General information

NPI: 1801445218
Provider Name (Legal Business Name): CHERYL S DERR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 NORTHEAST DR
HERSHEY PA
17033-2732
US

IV. Provider business mailing address

22 NORTHEAST DR
HERSHEY PA
17033-2732
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-6250
  • Fax: 717-531-6250
Mailing address:
  • Phone: 717-531-8338
  • Fax: 717-531-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP020625
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP020625
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: