Provider Demographics
NPI:1659821288
Name:DEARDORFF, HALLIE (CRNP)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:DEARDORFF
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:AMBER
Other - Last Name:KOCIEMBA
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:717-646-4201
Mailing Address - Fax:717-646-4202
Practice Address - Street 1:100 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-5241
Practice Address - Country:US
Practice Address - Phone:717-646-4201
Practice Address - Fax:717-646-4202
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN652053163W00000X
PASP016731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse