Healthcare Provider Details

I. General information

NPI: 1316647332
Provider Name (Legal Business Name): MARTA ROY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 PENNS VALLEY RD
SPRING MILLS PA
16875-8011
US

IV. Provider business mailing address

1800 E PARK AVE
STATE COLLEGE PA
16803-6701
US

V. Phone/Fax

Practice location:
  • Phone: 814-422-8873
  • Fax:
Mailing address:
  • Phone: 814-231-7000
  • Fax: 814-234-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP027051
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: