Provider Demographics
NPI:1356444517
Name:CETKOWSKI, RICHARD T JR (CRNP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:CETKOWSKI
Suffix:JR
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-733-6546
Mailing Address - Fax:717-733-6010
Practice Address - Street 1:446 N READING RD
Practice Address - Street 2:SUITE 301
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9802
Practice Address - Country:US
Practice Address - Phone:717-733-6546
Practice Address - Fax:717-733-6010
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1568941OtherGATEWAY-WMG
PA50073194OtherCAPITAL BLUE CROSS-YH
212350OtherJOHNS HOPKINS
PA102211740Medicaid
PA1926547OtherHIGHMARK BS FREEDOM BLUE
PA199629UFWMedicare PIN
PA50073194OtherCAPITAL BLUE CROSS-YH
PA1926547OtherHIGHMARK BS FREEDOM BLUE
PA1568941OtherGATEWAY-WMG