Healthcare Provider Details

I. General information

NPI: 1487216099
Provider Name (Legal Business Name): CORINNA RAE ROSENZWEIG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNA RAE GROTHE

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 CAPE HORN RD
RED LION PA
17356-8810
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-5888
  • Fax: 717-741-3709
Mailing address:
  • Phone: 717-812-5400
  • Fax: 717-741-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN661322P
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020499
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: