Healthcare Provider Details

I. General information

NPI: 1992139125
Provider Name (Legal Business Name): LAUREN GORDON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4595 NEW FALLS RD SUITE A
LEVITTOWN PA
19056
US

IV. Provider business mailing address

41 UNIVERSITY DR
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 267-587-3700
  • Fax: 215-949-2650
Mailing address:
  • Phone: 215-710-7037
  • Fax: 215-710-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014110
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: