Provider Demographics
NPI:1972732659
Name:GODFREY, LAUREN BRUNO (APN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BRUNO
Last Name:GODFREY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1306
Mailing Address - Country:US
Mailing Address - Phone:610-328-8058
Mailing Address - Fax:610-690-5724
Practice Address - Street 1:500 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1306
Practice Address - Country:US
Practice Address - Phone:610-328-8058
Practice Address - Fax:610-690-5724
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335496-1363LF0000X
PASP010896363LF0000X
DELG-0000561363LF0000X
DELG0000561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily