MEDICARE: LAUREN BRUNO GODFREY APN

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	F335496-1	NY
2	363LF0000X	Family Nurse Practitioner	SP010896	PA
3	363LF0000X	Family Nurse Practitioner	LG-0000561	DE

General Provider Information

NPI Number	:	1972732659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BRUNO GODFREY APN

Provider Business Mailing Address
First Line	:	500 COLLEGE AVE
Second Line	:
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1306
Country	:	US
Telephone Number	:	610-328-8058
Fax Number	:	610-690-5724

Provider Business Practice Location Address
First Line	:	500 COLLEGE AVE
Second Line	:
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1306
Country	:	US
Telephone Number	:	610-328-8058
Fax Number	:	610-690-5724

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

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	04/07/2016

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