Healthcare Provider Details

I. General information

NPI: 1215606900
Provider Name (Legal Business Name): LAURYN ALISSA EISTER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURYN ALISSA KENNEY CRNP

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SCENERY DR
STATE COLLEGE PA
16801-7974
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 800-230-4565
  • Fax: 814-235-5512
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP024293
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP024293
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: