MEDICARE: FENNY SUI CHING LAU 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	363LA2100X	Acute Care Nurse Practitioner	SP012070	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2750294	OTHER	PA	HIGHMARK BLUE SHIELD - FREEDOM BLUE

General Provider Information

NPI Number	:	1902152531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FENNY SUI CHING LAU CRNP

Provider Business Mailing Address
First Line	:	1803 MOUNT ROSE AVE
Second Line	:	SUITE B3
City	:	YORK
State	:	PA
Zip	:	17403-3026
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:	717-741-3598

Provider Business Practice Location Address
First Line	:	228 SAINT CHARLES WAY
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4644
Country	:	US
Telephone Number	:	717-812-5400
Fax Number	:	717-741-3598

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

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	11/30/2012

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