Healthcare Provider Details

I. General information

NPI: 1689170458
Provider Name (Legal Business Name): KATHRYN ROSE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 BROADCASTING RD STE 100
WYOMISSING PA
19610-3221
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-5673
  • Fax: 610-371-8623
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP018547
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: