Healthcare Provider Details

I. General information

NPI: 1174024566
Provider Name (Legal Business Name): BEATRICE TAIWO IJIYEMI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BEATRICE TAIWO ADEFALA

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GEORGE ST
YORK PA
17403-3676
US

IV. Provider business mailing address

601 MEMORY LN STE A
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-3467
  • Fax:
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP018323
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: