Provider Demographics
NPI:1427317114
Name:ECCLES, LAURA MARY (CRNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARY
Last Name:ECCLES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARY
Other - Last Name:LESOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:830 OLD LANCASTER RD
Mailing Address - Street 2:STE 209
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3118
Mailing Address - Country:US
Mailing Address - Phone:610-212-2803
Mailing Address - Fax:610-525-5309
Practice Address - Street 1:830 OLD LANCASTER RD
Practice Address - Street 2:STE 209
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3118
Practice Address - Country:US
Practice Address - Phone:610-212-2803
Practice Address - Fax:610-525-5309
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012099363LF0000X
PASP019346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily