Provider Demographics
NPI:1427721612
Name:RUPP, LAUREN M (CRNP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:RUPP
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:WALTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-741-8011
Mailing Address - Fax:717-255-0966
Practice Address - Street 1:35 MONUMENT RD STE 206
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5074
Practice Address - Country:US
Practice Address - Phone:717-741-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023998363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner