Healthcare Provider Details

I. General information

NPI: 1093808016
Provider Name (Legal Business Name): MARY PATRICIA DORENKAMP-REESE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 HARRISBURG PIKE SUITE 302
LANCASTER PA
17604
US

IV. Provider business mailing address

2110 HARRISBURG PIKE SUITE 302
LANCASTER PA
17604
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3364
  • Fax: 717-544-3365
Mailing address:
  • Phone: 717-544-3364
  • Fax: 717-544-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberUP005726B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: