Healthcare Provider Details

I. General information

NPI: 1952517039
Provider Name (Legal Business Name): LISA A BAURLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MERION AVE BRYN MAWR COLLEGE HEALTH CENTER
BRYN MAWR PA
19010
US

IV. Provider business mailing address

520 TULIP LANE
KING OF PRUSSIA PA
19406
US

V. Phone/Fax

Practice location:
  • Phone: 610-526-7360
  • Fax: 610-526-7365
Mailing address:
  • Phone: 610-878-9547
  • Fax: 610-878-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN286106L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: