1144272337 NPI number — ROSE A MEDICE CRNP

Table of content: ROSE A MEDICE CRNP (NPI 1144272337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144272337 NPI number — ROSE A MEDICE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDICE
Provider First Name:
ROSE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144272337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4131 OREGON PIKE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
EPHRATA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17522-9550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-859-5161
Provider Business Mailing Address Fax Number:
717-859-5169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4131 OREGON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17508-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-859-1123
Provider Business Practice Location Address Fax Number:
717-859-2898
Provider Enumeration Date:
05/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP007969 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)