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NPI Code Detail

MEDICARE: KLA J BROSIUS CRNP

MEDICARE: KLA J BROSIUS CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerSP029731PA
2363L00000XNurse PractitionerSP022125PA
3363LF0000XFamily Nurse PractitionerSP022125PA
4363L00000XNurse PractitionerRN703306PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114672457OTHERPACAQH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31043620669OTHERNPI

General Provider Information

NPI Number : 1043620669
Entity Type Code : Individual
Provider Name (Legal Business Name) : KLA J BROSIUS CRNP
Provider Business Mailing Address
First Line : 601 MEMORY LN
Second Line :
City : YORK
State : PA
Zip : 17402-2231
Country : US
Telephone Number : 717-851-1405
Fax Number : 717-851-6969
Provider Business Practice Location Address
First Line : 8131 SPYGLASS HILL DR
Second Line :
City : FAYETTEVILLE
State : PA
Zip : 17222-5500
Country : US
Telephone Number : 717-749-3181
Fax Number : 717-349-3191
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2014
Last Update Date : 12/05/2025

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Directions to “ KLA J BROSIUS CRNP” Practice Location

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