Healthcare Provider Details

I. General information

NPI: 1346610359
Provider Name (Legal Business Name): BRITTANY LAUTZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 W BALTIMORE PIKE STE 2104 RIDDLE HCC #2
MEDIA PA
19063-5136
US

IV. Provider business mailing address

1088 W BALTIMORE PIKE STE 2104 RIDDLE HCC #2
MEDIA PA
19063-5136
US

V. Phone/Fax

Practice location:
  • Phone: 610-744-2980
  • Fax: 610-744-2982
Mailing address:
  • Phone: 610-744-2980
  • Fax: 610-744-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015514
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN625373
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: