Provider Demographics
NPI:1710302013
Name:SAPKO, LAUREN MARY (CRNA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARY
Last Name:SAPKO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARY
Other - Last Name:SWETLECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3945 S ATHERTON ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-8308
Mailing Address - Country:US
Mailing Address - Phone:814-466-5090
Mailing Address - Fax:814-466-5095
Practice Address - Street 1:1800 E PARK AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6709
Practice Address - Country:US
Practice Address - Phone:814-231-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-23
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN588080367500000X
PA588080163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029275330001Medicaid
PA1029275330001Medicaid