MEDICARE: ANDREW OUELLET CRNP; FNP-C

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
1	363LF0000X	Family Nurse Practitioner	SP025620	PA

General Provider Information

NPI Number	:	1578293999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW OUELLET CRNP; FNP-C

Provider Business Mailing Address
First Line	:	310 N GEORGE ST
Second Line	:
City	:	MILLERSVILLE
State	:	PA
Zip	:	17551-1524
Country	:	US
Telephone Number	:	203-805-9982
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 HAMPDEN DR
Second Line	:
City	:	STRASBURG
State	:	PA
Zip	:	17579-1123
Country	:	US
Telephone Number	:	717-687-0313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/23/2022

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