Healthcare Provider Details

I. General information

NPI: 1154937902
Provider Name (Legal Business Name): CRISSY PATIERNO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MEMORY LANE EXT
YORK PA
17402-9601
US

IV. Provider business mailing address

3025 FREYSVILLE RD
RED LION PA
17356-8724
US

V. Phone/Fax

Practice location:
  • Phone: 717-757-5433
  • Fax:
Mailing address:
  • Phone: 717-332-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022336
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: