Provider Demographics
NPI:1568937423
Name:PAVELKO, ERICA R (CRNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:R
Last Name:PAVELKO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:R
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
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:717-270-4876
Mailing Address - Fax:717-270-3875
Practice Address - Street 1:252 S 4TH ST FL 3
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6111
Practice Address - Country:US
Practice Address - Phone:717-270-4876
Practice Address - Fax:717-270-3875
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN649194208M00000X
PASP019356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist