Provider Demographics
NPI:1730696246
Name:LAU, BRIAN MARTIN (L OM, RN, L AC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MARTIN
Last Name:LAU
Suffix:
Gender:M
Credentials:L OM, RN, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W CARACAS AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1567
Mailing Address - Country:US
Mailing Address - Phone:717-832-4111
Mailing Address - Fax:
Practice Address - Street 1:203 W CARACAS AVE STE 203
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:410-794-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN147147163W00000X
PARN703740163W00000X
AZ1081171100000X
PAOM000234171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse