Provider Demographics
NPI:1972130441
Name:BORN, STEPHANIE IRENE ELDRIDGE (CRNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:IRENE ELDRIDGE
Last Name:BORN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:IRENE
Other - Last Name:BORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
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:717-851-5736
Mailing Address - Fax:717-851-6162
Practice Address - Street 1:130 PINE GROVE CMNS
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5151
Practice Address - Country:US
Practice Address - Phone:717-851-5736
Practice Address - Fax:717-851-6162
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021694363LF0000X
PAMB5885908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily