MEDICARE: LAURA EMLIY MALEKNIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP019071	PA

General Provider Information

NPI Number	:	1851874465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA EMLIY MALEKNIA

Provider Business Mailing Address
First Line	:	1307 PHOENIXVILLE PIKE
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-1435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 PHOENIXVILLE PIKE
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-1435
Country	:	US
Telephone Number	:	833-423-7334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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