Provider Demographics
NPI:1417142514
Name:STORBRAUCK, ANN MARIE THERESA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:THERESA
Last Name:STORBRAUCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:ANN MARIE
Other - Middle Name:THERESA
Other - Last Name:MIGNONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2813 LEE DR
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1047
Mailing Address - Country:US
Mailing Address - Phone:215-350-9528
Mailing Address - Fax:
Practice Address - Street 1:2813 LEE DR
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1047
Practice Address - Country:US
Practice Address - Phone:215-350-9528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009486363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health