Provider Demographics
NPI:1306404082
Name:RODRIGUEZ, STEVEN (CRNP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BERNVILLE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9453
Mailing Address - Country:US
Mailing Address - Phone:610-378-2000
Mailing Address - Fax:610-378-2799
Practice Address - Street 1:108 PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9454
Practice Address - Country:US
Practice Address - Phone:610-208-4650
Practice Address - Fax:610-916-2787
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty