Healthcare Provider Details

I. General information

NPI: 1649714668
Provider Name (Legal Business Name): LAUREN HOSTETLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

PO BOX 828962
PHILADELPHIA PA
19182-8962
US

V. Phone/Fax

Practice location:
  • Phone: 610-645-2000
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN639694
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: