Provider Demographics
NPI:1508990953
Name:KNAUER, LAURA SELLERS (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SELLERS
Last Name:KNAUER
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 1:4829 STREET ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053
Mailing Address - Country:US
Mailing Address - Phone:215-364-5800
Mailing Address - Fax:215-364-5899
Practice Address - Street 1:270 COMMERCE DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034
Practice Address - Country:US
Practice Address - Phone:215-653-0600
Practice Address - Fax:215-646-4422
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006393D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATP006393 DOtherCRNP LICENSE
PA004150OtherCRNP PRESCRIPTIVE AUTH
PARN279111LOtherRNLICENSE