Provider Demographics
NPI:1124072988
Name:HITCHCOCK, MARY LAURA (CRNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LAURA
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7800
Mailing Address - Fax:717-812-7811
Practice Address - Street 1:4222 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8083
Practice Address - Country:US
Practice Address - Phone:717-812-7800
Practice Address - Fax:717-812-7811
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN037974163WW0101X
LAAP01173363LW0102X
PASP000141F363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPO0341287OtherRAILROAD MEDICARE
PA565985FLTOtherMEDICARE
LA1692231Medicaid
LA1692231Medicaid
PAP00341287Medicare PIN
S55441Medicare UPIN
PAP00341287Medicare PIN
PA1552443OtherGATEWAY-WMG
S55441Medicare UPIN