Provider Demographics
NPI:1053064063
Name:MECOUCH, CHRISTIE J (CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:J
Last Name:MECOUCH
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 1:2221 NOLL DR STE 2000
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-7614
Mailing Address - Country:US
Mailing Address - Phone:717-715-1001
Mailing Address - Fax:717-431-2321
Practice Address - Street 1:2221 NOLL DR STE 2000
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7614
Practice Address - Country:US
Practice Address - Phone:717-715-1001
Practice Address - Fax:717-431-2321
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023460363LF0000X
PATP006109D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily