Healthcare Provider Details

I. General information

NPI: 1366184889
Provider Name (Legal Business Name): LAURA BEALER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CETRONIA RD
ALLENTOWN PA
18104-9569
US

IV. Provider business mailing address

801 OSTRUM STREET ENROLLMENTS
BETHLEHEM PA
18015
US

V. Phone/Fax

Practice location:
  • Phone: 484-426-2501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP024576
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: