Healthcare Provider Details

I. General information

NPI: 1881428464
Provider Name (Legal Business Name): LAUREN ANN BLUE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN ANN BAMBINO

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ROSE ST
JOHNSTOWN PA
15905-4327
US

IV. Provider business mailing address

1339 BENSHOFF HILL RD
JOHNSTOWN PA
15906-3810
US

V. Phone/Fax

Practice location:
  • Phone: 814-539-0257
  • Fax:
Mailing address:
  • Phone: 814-248-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP029697
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP029697
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: