Healthcare Provider Details

I. General information

NPI: 1780172163
Provider Name (Legal Business Name): LAURA M KOONCE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 7TH AVE STE 2020
WEST READING PA
19611-1495
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 610-375-6565
  • Fax: 610-375-2065
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN620385
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberSP018904
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: