Healthcare Provider Details

I. General information

NPI: 1356835656
Provider Name (Legal Business Name): BRANDI NIKOHL RICHARDSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI NIKOHL HOLLERBUSH

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 FREEDOM WAY STE 200
YORK PA
17402-8200
US

IV. Provider business mailing address

2350 FREEDOM WAY STE 200
YORK PA
17402-8200
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-5120
  • Fax:
Mailing address:
  • Phone: 717-812-5120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019151
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: