Healthcare Provider Details

I. General information

NPI: 1306464847
Provider Name (Legal Business Name): CATHERINE WASELKOV CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7500
  • Fax:
Mailing address:
  • Phone: 717-272-8173
  • Fax: 717-272-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberSP021774
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: