Provider Demographics
NPI:1477153179
Name:HUMMEL, LAURA OLIVIA (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:OLIVIA
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:270 SUSQUEHANNA VALLEY MALL DR STE 800
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9124
Practice Address - Country:US
Practice Address - Phone:570-884-7925
Practice Address - Fax:570-374-0176
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022562363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103849084Medicaid
PA1J9872OtherMEDICARE