Healthcare Provider Details

I. General information

NPI: 1053397091
Provider Name (Legal Business Name): GLORIA JEAN CISSNE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/07/2023
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 HARRISBURG PIKE SUITE 1
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2106 HARRISBURG PIKE SUITE 1
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-291-5931
  • Fax: 717-291-5818
Mailing address:
  • Phone: 717-291-5931
  • Fax: 717-291-5818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP008602
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: