Healthcare Provider Details

I. General information

NPI: 1104525237
Provider Name (Legal Business Name): NELIZA JANE LAO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W SCHUYLKILL RD STE G-15A
POTTSTOWN PA
19465-7438
US

IV. Provider business mailing address

351 W SCHUYLKILL RD STE G-15A
POTTSTOWN PA
19465-7438
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-9460
  • Fax:
Mailing address:
  • Phone: 610-326-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP027123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: