Healthcare Provider Details

I. General information

NPI: 1780467019
Provider Name (Legal Business Name): MARIA ENRIQUETA RYCZEK CRNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ELISE WAY
STROUDSBURG PA
18360-7646
US

IV. Provider business mailing address

112 ELISE WAY
STROUDSBURG PA
18360-7646
US

V. Phone/Fax

Practice location:
  • Phone: 570-807-6320
  • Fax:
Mailing address:
  • Phone: 570-807-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP027976
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: