Provider Demographics
NPI:1467097253
Name:MOYER, LAURA ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:MOYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-9345
Mailing Address - Country:US
Mailing Address - Phone:717-269-7563
Mailing Address - Fax:
Practice Address - Street 1:33 TEEN CHALLENGE RD
Practice Address - Street 2:
Practice Address - City:REHRERSBURG
Practice Address - State:PA
Practice Address - Zip Code:19550-5000
Practice Address - Country:US
Practice Address - Phone:717-933-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily