Individual
LAURIE JANE TIRTANADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CPNP
Contact information
Practice address
401 PENN ST, READING, PA 19601
(855) 453-2327
Mailing address
209 HOYA AVE, HARRISBURG, PA 17112-9459
(415) 518-2998
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R095036
MD
363L00000X
Nurse Practitioner
Primary
SP017662
PA
363LF0000X
Family Nurse Practitioner
19767
CA
363LP0200X
Pediatric Nurse Practitioner
19767
CA
Other
Enumeration date
12/04/2006
Last updated
01/22/2019
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