Provider Demographics
NPI:1386369296
Name:FORTNEY, ANDREW EMANUEL (CRNP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:EMANUEL
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PARK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1375
Mailing Address - Country:US
Mailing Address - Phone:717-731-2800
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD STE 407
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-874-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273R00000X
PASP025957363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No273R00000XHospital UnitsPsychiatric Unit