Healthcare Provider Details

I. General information

NPI: 1356723613
Provider Name (Legal Business Name): RYNDA ROSS GANSTER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E. MARSHALL ST.
WEST CHESTER PA
19380
US

IV. Provider business mailing address

400 E. MARSHALL ST.
WEST CHESTER PA
19380
US

V. Phone/Fax

Practice location:
  • Phone: 610-696-6511
  • Fax: 610-429-1840
Mailing address:
  • Phone: 610-696-6511
  • Fax: 610-429-1840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP014840
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP014840
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP014840
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP014840
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: