Healthcare Provider Details

I. General information

NPI: 1205854338
Provider Name (Legal Business Name): AMY HOLBERT RAINES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S GEORGE ST STE 200
YORK PA
17401-3160
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-2334
  • Fax: 717-851-3498
Mailing address:
  • Phone: 717-851-4005
  • Fax: 717-812-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberUP001654B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: