Healthcare Provider Details

I. General information

NPI: 1477931012
Provider Name (Legal Business Name): ABA FAHNBULLEH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA PARKER

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GEORGE ST FL 2
YORK PA
17403
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-2914
  • Fax: 717-851-2479
Mailing address:
  • Phone: 717-851-2914
  • Fax: 717-851-2479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSPO14415
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014415
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: