Healthcare Provider Details

I. General information

NPI: 1396028502
Provider Name (Legal Business Name): PAMELA MARIE HOLLENBACH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 COUNTRY CLUB RD
YORK PA
17403-3651
US

IV. Provider business mailing address

441 COUNTRY CLUB RD
YORK PA
17403-3651
US

V. Phone/Fax

Practice location:
  • Phone: 717-815-1381
  • Fax:
Mailing address:
  • Phone: 717-815-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP004519C
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP004520V
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: