Healthcare Provider Details

I. General information

NPI: 1659091320
Provider Name (Legal Business Name): STEPHANIE MARIE GILLESPIE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 HELEN DR
LEBANON PA
17042-7493
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-8835
  • Fax: 717-202-0100
Mailing address:
  • Phone: 717-273-8835
  • Fax: 717-202-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP025580
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: