Provider Demographics
NPI:1073585634
Name:STAUFFER, AMY LYTER (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYTER
Last Name:STAUFFER
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 1:500 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-3503
Mailing Address - Fax:717-531-4375
Practice Address - Street 1:35 HOPE DR
Practice Address - Street 2:SUITE 202-204
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2086
Practice Address - Country:US
Practice Address - Phone:717-531-3503
Practice Address - Fax:717-531-4375
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005859V363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50026640OtherCAPITAL BLUE CROSS
PA1399970OtherHIGHMARK BLUE SHIELD
PA062910Medicare PIN
PA50026640OtherCAPITAL BLUE CROSS