Provider Demographics
NPI:1518369594
Name:MORTAGUA, LAUREN (CRNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MORTAGUA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:ZIMPFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1590 MEDICAL DR STE E
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3247
Mailing Address - Country:US
Mailing Address - Phone:610-326-4980
Mailing Address - Fax:
Practice Address - Street 1:1590 MEDICAL DR STE E
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3247
Practice Address - Country:US
Practice Address - Phone:610-326-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014231363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics