Provider Demographics
NPI:1902152531
Name:LAU, FENNY SUI CHING (CRNP)
Entity Type:Individual
Prefix:
First Name:FENNY
Middle Name:SUI CHING
Last Name:LAU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-741-3598
Practice Address - Street 1:228 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4644
Practice Address - Country:US
Practice Address - Phone:717-812-5400
Practice Address - Fax:717-741-3598
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012070363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2750294OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PA247994FLTMedicare PIN