Provider Demographics
NPI:1487624367
Name:HIMMELSBACH, ALAN JOSEPH (CRNP)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:JOSEPH
Last Name:HIMMELSBACH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 BROOKHILL SQUARE SOUTH
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-1701
Mailing Address - Country:US
Mailing Address - Phone:570-459-0029
Mailing Address - Fax:610-687-5350
Practice Address - Street 1:8 BROOKHILL SQUARE SOUTH
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-1824
Practice Address - Country:US
Practice Address - Phone:570-459-0029
Practice Address - Fax:570-454-5757
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007748363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner