Provider Demographics
NPI:1417305335
Name:GUPTA, NISHA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:NISHA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:NISHA
Other - Middle Name:
Other - Last Name:AGGARWAL
Other - Suffix:
Other - Last Name Type:Former Name
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:717-274-5500
Mailing Address - Fax:717-274-5189
Practice Address - Street 1:775 NORMAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7497
Practice Address - Country:US
Practice Address - Phone:717-274-5500
Practice Address - Fax:717-274-5189
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103109975Medicaid
PA506104Medicare PIN
PACA1044OtherRRMC GROUP #