Healthcare Provider Details

I. General information

NPI: 1124072988
Provider Name (Legal Business Name): MARY LAURA HITCHCOCK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 LINCOLN HWY
YORK PA
17406-8083
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-7800
  • Fax: 717-812-7811
Mailing address:
  • Phone: 717-812-7800
  • Fax: 717-812-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN037974
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP01173
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP000141F
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: