Provider Demographics
NPI:1093808016
Name:DORENKAMP-REESE, MARY PATRICIA (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:DORENKAMP-REESE
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 1:2110 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604
Mailing Address - Country:US
Mailing Address - Phone:717-544-3364
Mailing Address - Fax:717-544-3365
Practice Address - Street 1:2110 HARRISBURG PIKE
Practice Address - Street 2:SUITE 302
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604
Practice Address - Country:US
Practice Address - Phone:717-544-3364
Practice Address - Fax:717-544-3365
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005726B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012737020001Medicaid
PA052780MP1Medicare PIN
P44199Medicare UPIN