Provider Demographics
NPI:1801412465
Name:ROHRBACK, JUSTIN (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:ROHRBACK
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 DELTA RD
Mailing Address - Street 2:
Mailing Address - City:BROGUE
Mailing Address - State:PA
Mailing Address - Zip Code:17309-9106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 DELTA RD
Practice Address - Street 2:
Practice Address - City:BROGUE
Practice Address - State:PA
Practice Address - Zip Code:17309-9106
Practice Address - Country:US
Practice Address - Phone:717-927-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022119363LF0000X
PARN700337163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse