1104815000 NPI number — MRS. LAURA MARIE STEIN CRNP

Table of content: MRS. LAURA MARIE STEIN CRNP (NPI 1104815000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104815000 NPI number — MRS. LAURA MARIE STEIN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEIN
Provider First Name:
LAURA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLOSS
Provider Other First Name:
LAURA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104815000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 PINE GROVE COMMONS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17403-5161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-755-4422
Provider Business Mailing Address Fax Number:
717-755-2390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 PINE GROVE COMMONS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-5161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-755-4422
Provider Business Practice Location Address Fax Number:
717-755-2390
Provider Enumeration Date:
10/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  SP007689 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)