Provider Demographics
NPI:1760041081
Name:LAFOUNTAIN, BRANDI J (CRNP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:J
Last Name:LAFOUNTAIN
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 1:2500 BERNVILLE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9453
Mailing Address - Country:US
Mailing Address - Phone:610-368-2000
Mailing Address - Fax:610-378-2799
Practice Address - Street 1:108 PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9475
Practice Address - Country:US
Practice Address - Phone:610-208-4650
Practice Address - Fax:610-916-2787
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily