Healthcare Provider Details

I. General information

NPI: 1316340730
Provider Name (Legal Business Name): ALEXANDRIA DEROSE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 MARIETTA AVE
LANCASTER PA
17601-1321
US

IV. Provider business mailing address

3045 MARIETTA AVE
LANCASTER PA
17601-1321
US

V. Phone/Fax

Practice location:
  • Phone: 717-898-2900
  • Fax: 717-898-3275
Mailing address:
  • Phone: 717-898-2900
  • Fax: 717-898-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014293
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN617744
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: