Provider Demographics
NPI:1508920109
Name:PISTILLI, KAREN A (CNM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:PISTILLI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:EADICICCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:3025 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4518
Practice Address - Country:US
Practice Address - Phone:717-761-8900
Practice Address - Fax:717-761-1320
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010033367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031396240001Medicaid
PA93888OtherGEISINGER