Healthcare Provider Details

I. General information

NPI: 1730576158
Provider Name (Legal Business Name): JOHN PAUL SHANK CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 SAINT CHARLES WAY STE 300
YORK PA
17402-4661
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-5400
  • Fax: 717-741-3598
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015034
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: