Provider Demographics
NPI:1164033916
Name:REIDER, KERSTEN ELIZABETH (CRNP)
Entity Type:Individual
Prefix:
First Name:KERSTEN
Middle Name:ELIZABETH
Last Name:REIDER
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 1:71 KALEY CT
Mailing Address - Street 2:
Mailing Address - City:MOHRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19541-9708
Mailing Address - Country:US
Mailing Address - Phone:610-781-1633
Mailing Address - Fax:
Practice Address - Street 1:2234 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PENN
Practice Address - State:PA
Practice Address - Zip Code:19606-1830
Practice Address - Country:US
Practice Address - Phone:610-370-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022230363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care