Healthcare Provider Details

I. General information

NPI: 1497433148
Provider Name (Legal Business Name): LAUREN ANN COLLETTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN ANN GRIFFIN

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST
PHILADELPHIA PA
19107-6192
US

IV. Provider business mailing address

800 SPRUCE ST
PHILADELPHIA PA
19107-6192
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-7817
  • Fax:
Mailing address:
  • Phone: 215-829-7817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: