Healthcare Provider Details

I. General information

NPI: 1053756775
Provider Name (Legal Business Name): DANA D LAVERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA D CORTESE

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 W CHESTER PIKE STE 300
NEWTOWN SQUARE PA
19073-2304
US

IV. Provider business mailing address

3803 W CHESTER PIKE STE 160
NEWTOWN SQUARE PA
19073-2336
US

V. Phone/Fax

Practice location:
  • Phone: 484-337-2585
  • Fax:
Mailing address:
  • Phone: 484-337-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013483
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP013483
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: