Healthcare Provider Details

I. General information

NPI: 1093119091
Provider Name (Legal Business Name): LAURA HANES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA FORSYTHE

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S COLDBROOK AVE
CHAMBERSBURG PA
17201-2712
US

IV. Provider business mailing address

785 5TH AVE SUITE 3
CHAMBERSBURG PA
17201-4232
US

V. Phone/Fax

Practice location:
  • Phone: 717-267-7480
  • Fax: 717-267-7403
Mailing address:
  • Phone: 717-263-9555
  • Fax: 717-267-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNPPA021756
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: