Individual
LAURELL SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5189
(215) 707-8306
Mailing address
1605 NORRISTOWN RD, AMBLER, PA 19002-2744
(267) 970-1694
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP024642
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP024642
CRNP LICENSE NUMBER
PA
Enumeration date
11/17/2021
Last updated
11/17/2021
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