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 1:3400 SPRUCE STREET
Mailing Address - Street 2:3 SILVERSTEIN BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-3487
Mailing Address - Fax:215-349-5534
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:3 SILVERSTEIN BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-3487
Practice Address - Fax:215-349-5534
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012099363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology