Healthcare Provider Details

I. General information

NPI: 1104221415
Provider Name (Legal Business Name): STEPHANIE ANN SANDERS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN WILLIAMS

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONUMENT RD STE 295
YORK PA
17403-5049
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-356-5864
  • Fax: 717-409-6221
Mailing address:
  • Phone: 717-356-5864
  • Fax: 717-409-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP014364
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR161540
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP014364
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: