Healthcare Provider Details

I. General information

NPI: 1770081291
Provider Name (Legal Business Name): HEATHER MARIE LUPOLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER MARIE CARTER

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EVELYN DR
MILLERSBURG PA
17061-1258
US

IV. Provider business mailing address

110 S 17TH ST
HARRISBURG PA
17104-1123
US

V. Phone/Fax

Practice location:
  • Phone: 717-232-9971
  • Fax:
Mailing address:
  • Phone: 717-232-9971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN577761
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP018894
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: