Healthcare Provider Details

I. General information

NPI: 1134948862
Provider Name (Legal Business Name): LORI ANN FRAVEL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

360 FETTER RD
SELINSGROVE PA
17870-8440
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6328
  • Fax: 570-271-6955
Mailing address:
  • Phone: 570-541-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP030739
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: