1740782366 NPI number — MRS. KELLI RENEE OSWALD CRNP

Table of content: MRS. KELLI RENEE OSWALD CRNP (NPI 1740782366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740782366 NPI number — MRS. KELLI RENEE OSWALD CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSWALD
Provider First Name:
KELLI
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
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:
YINGLING
Provider Other First Name:
KELLI
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740782366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 RAYLOC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANCOCK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21750-1518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-678-5187
Provider Business Mailing Address Fax Number:
301-678-5797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 FULTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC CONNELLSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17233-8061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-485-3850
Provider Business Practice Location Address Fax Number:
717-485-3725
Provider Enumeration Date:
02/28/2018

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:  SP018650 , 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)