MEDICARE: LAURI G WEISS CRNP

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	363LA2200X	Adult Health Nurse Practitioner	SP010409	PA

General Provider Information

NPI Number	:	1851602304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURI G WEISS CRNP

Provider Business Mailing Address
First Line	:	12265 TOWNSEND RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1201
Country	:	US
Telephone Number	:	215-856-1303
Fax Number	:	215-856-1300

Provider Business Practice Location Address
First Line	:	12265 TOWNSEND RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1201
Country	:	US
Telephone Number	:	215-856-1303
Fax Number	:	215-856-1300

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

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	06/30/2010

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