Provider Demographics
NPI:1750328035
Name:VAN METRE, MARY (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:VAN METRE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:CHADROFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:116 S GEORGE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-1408
Mailing Address - Country:US
Mailing Address - Phone:717-801-4866
Mailing Address - Fax:717-854-6645
Practice Address - Street 1:116 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-1408
Practice Address - Country:US
Practice Address - Phone:717-845-8617
Practice Address - Fax:717-854-6645
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP000600B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ42251OtherHEALTH AMERICA/HEALTH ASS
PA50049643OtherCAPITAL BLUE CROSS/KEYSTO
PA50049643OtherCAPITAL BLUE CROSS/KEYSTO
PAQ42251OtherHEALTH AMERICA/HEALTH ASS