Provider Demographics
NPI:1538756952
Name:TABER, LAURA H (CRNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:TABER
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:PO BOX 22573
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2573
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:915 OLD FERN HILL RD STE 600
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3421
Practice Address - Country:US
Practice Address - Phone:610-692-3434
Practice Address - Fax:610-692-9005
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022122363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2150119OtherUHC
PA004556927OtherHIGHMARK
PA004557445OtherIBC
PA104081752Medicaid