Healthcare Provider Details

I. General information

NPI: 1518582550
Provider Name (Legal Business Name): MARYKATE CONROY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 COLONIAL VILLAGE LN STE 103
LANCASTER PA
17601-6709
US

IV. Provider business mailing address

4600 E HARRISBURG PIKE
ELIZABETHTOWN PA
17022-9004
US

V. Phone/Fax

Practice location:
  • Phone: 484-818-0052
  • Fax:
Mailing address:
  • Phone: 484-818-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP024376
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP024376
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN627315
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: