Provider Demographics
NPI:1104201862
Name:DETWILER, CHRISTINE (CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DETWILER
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 1:350 SHEETZ WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16625-8346
Mailing Address - Country:US
Mailing Address - Phone:814-239-1516
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5681
Practice Address - Fax:717-544-4665
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA427724FLTMedicare PIN