Healthcare Provider Details

I. General information

NPI: 1376038505
Provider Name (Legal Business Name): STEPHANIE K GLICK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
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: 717-723-4369
Mailing address:
  • Phone: 717-299-5711
  • Fax: 717-723-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018948
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-2691
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: