MEDICARE: MS. LAURA HERBENER CRNP, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11030910	FL
2	363LF0000X	Family Nurse Practitioner	SP015107	PA

General Provider Information

NPI Number	:	1285012526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA HERBENER CRNP, FNP-C

Provider Business Mailing Address
First Line	:	1601 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19192-0003
Country	:	US
Telephone Number	:	215-761-3939
Fax Number	:	215-761-5602

Provider Business Practice Location Address
First Line	:	1601 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19192-0003
Country	:	US
Telephone Number	:	215-761-3939
Fax Number	:	215-761-5602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	04/02/2024

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