Provider Demographics
NPI:1750640603
Name:KING, LAUREN MARIE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:WALERYSZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-4005
Mailing Address - Fax:717-812-2495
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PWSP014036363L00000X
PASP014036363LA2200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA364913FLTMedicare PIN
PAP01443947Medicare PIN