Healthcare Provider Details

I. General information

NPI: 1982256855
Provider Name (Legal Business Name): MICHELLE NGUYEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 HARRISBURG PIKE STE 327
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2110 HARRISBURG PIKE STE 327
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3216
  • Fax: 717-544-3096
Mailing address:
  • Phone: 717-544-3216
  • Fax: 717-544-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN634680
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP020098
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: