Healthcare Provider Details

I. General information

NPI: 1811539034
Provider Name (Legal Business Name): KRISTEN LYNN WHITEBREAD-WOOD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PETERS RD STE 200
LITITZ PA
17543-7685
US

IV. Provider business mailing address

51 PETERS RD STE 200
LITITZ PA
17543-7685
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-2167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020595
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: