Provider Demographics
NPI:1679939797
Name:MAROSOK, ANDRA RIELA (CRNP)
Entity type:Individual
Prefix:
First Name:ANDRA
Middle Name:RIELA
Last Name:MAROSOK
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 1:2112 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3022
Mailing Address - Fax:717-544-3021
Practice Address - Street 1:2112 HARRISBURG PIKE
Practice Address - Street 2:SUITE 312
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3022
Practice Address - Fax:717-544-3021
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015840363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health