Healthcare Provider Details

I. General information

NPI: 1083439897
Provider Name (Legal Business Name): ANDREA JUSTICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PINE GROVE CMNS
YORK PA
17403-5151
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-5736
  • Fax: 717-715-1298
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030957
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: