Healthcare Provider Details

I. General information

NPI: 1508899063
Provider Name (Legal Business Name): KRISTEN M NEBEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN M GRIFFIN DO

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 PIONEER RD
LANCASTER PA
17602-1516
US

IV. Provider business mailing address

1762 PIONEER RD
LANCASTER PA
17602-1516
US

V. Phone/Fax

Practice location:
  • Phone: 717-723-8531
  • Fax: 717-482-0242
Mailing address:
  • Phone: 717-723-8531
  • Fax: 717-482-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS013415
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: