Provider Demographics
NPI:1972814150
Name:ZDANCEWICZ, LAURA (MSN, CRNP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:ZDANCEWICZ
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18651-4110
Mailing Address - Country:US
Mailing Address - Phone:570-288-1171
Mailing Address - Fax:
Practice Address - Street 1:2453 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LARKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18651-4110
Practice Address - Country:US
Practice Address - Phone:570-288-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP-06446-B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily