Healthcare Provider Details

I. General information

NPI: 1114857299
Provider Name (Legal Business Name): BROOKE STOVER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 HUNTER HOLLOW RD
LOCK HAVEN PA
17745-8148
US

IV. Provider business mailing address

64 HUNTER HOLLOW RD
LOCK HAVEN PA
17745-8148
US

V. Phone/Fax

Practice location:
  • Phone: 570-295-2670
  • Fax:
Mailing address:
  • Phone: 570-295-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP036042
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: