Healthcare Provider Details

I. General information

NPI: 1528822582
Provider Name (Legal Business Name): JACQUELINE DREW SEXTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MANHEIM PIKE STE 202
LANCASTER PA
17601-3127
US

IV. Provider business mailing address

2913 SUNSET DR
CAMP HILL PA
17011-1633
US

V. Phone/Fax

Practice location:
  • Phone: 717-791-2520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP029055
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: