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General NPI Number Information
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NPI Number | 1437227055
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Entity Type | Organization
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Legal Business Name | WELLSPAN MEDICAL GROUP
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 235 ROSEDALE DR
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City | MANCHESTER
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State | PA
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Zip | 17345-1022
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Country | US
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Telephone | 717-812-5229
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Fax | 717-266-7453
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Provider Business Mailing Address
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Address Line | 1803 MOUNT ROSE AVE SUITE B3
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City | YORK
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State | PA
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Zip | 17403-3051
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Country | US
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Telephone | 717-851-1405
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Fax | 717-266-7453
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | MS. TINA VEST
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Credential |
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Telephone | 717-851-6928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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