Provider Demographics
NPI:1831859834
Name:VANDENBERG, LAURA ANN
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 WILDFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-5004
Mailing Address - Country:US
Mailing Address - Phone:848-888-5867
Mailing Address - Fax:
Practice Address - Street 1:1055 WESTLAKES DR STE 3152
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-2410
Practice Address - Country:US
Practice Address - Phone:212-346-6050
Practice Address - Fax:212-220-3562
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-19
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily