Healthcare Provider Details

I. General information

NPI: 1881886034
Provider Name (Legal Business Name): LAUREN KRISTEN SULOVSKI P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAUREN KRISTEN JOHANSEN

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSTRUM ST SUITE 203
FOUNTAIN HILL PA
18015-1155
US

IV. Provider business mailing address

701 OSTRUM ST SUITE 203
FOUNTAIN HILL PA
18015-1155
US

V. Phone/Fax

Practice location:
  • Phone: 610-691-3603
  • Fax:
Mailing address:
  • Phone: 610-691-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00184000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMD053030
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00184000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: