Healthcare Provider Details

I. General information

NPI: 1568851236
Provider Name (Legal Business Name): DUANE CECIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 GARDENIA CT
LITITZ PA
17543-8307
US

IV. Provider business mailing address

215 GARDENIA CT
LITITZ PA
17543-8307
US

V. Phone/Fax

Practice location:
  • Phone: 717-584-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number05680501
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number05680501
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number05680501
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number05680501
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: