Healthcare Provider Details

I. General information

NPI: 1487953873
Provider Name (Legal Business Name): RACHEL HOLLY DOTY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL HOLLY MILLER CRNP

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 EASTBROOK RD
RONKS PA
17572-9769
US

IV. Provider business mailing address

29 EASTBROOK RD
RONKS PA
17572-9769
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-5711
  • Fax:
Mailing address:
  • Phone: 717-299-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN604764
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP011326
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: