Provider Demographics
NPI:1780822338
Name:SOLOMON, LAUREN JOHNSON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:JOHNSON
Last Name:SOLOMON
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 1:4126 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3511
Mailing Address - Country:US
Mailing Address - Phone:215-387-0500
Mailing Address - Fax:
Practice Address - Street 1:4126 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3511
Practice Address - Country:US
Practice Address - Phone:215-387-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010139363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007278000OtherPA MEDICAID TPI GROUP
PACD4829OtherTPI GROUP RAILROAD MEDICARE
PA598576OtherMEDICARE TPI GROUP