Healthcare Provider Details

I. General information

NPI: 1609780196
Provider Name (Legal Business Name): LAUREN FLUDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

105 RUTLAND WAY
WOOLWICH TOWNSHIP NJ
08085-3257
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP032842
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: