Healthcare Provider Details

I. General information

NPI: 1710302013
Provider Name (Legal Business Name): LAUREN MARY SAPKO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MARY SWETLECH

II. Dates (important events)

Enumeration Date: 02/23/2014
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E PARK AVE
STATE COLLEGE PA
16803-6709
US

IV. Provider business mailing address

3945 S ATHERTON ST
STATE COLLEGE PA
16801-8308
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-7000
  • Fax:
Mailing address:
  • Phone: 814-466-5090
  • Fax: 814-466-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN588080
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number588080
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: