Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | UP001993B | PA |
NPI | 1003830084 |
---|---|
Provider Name | Laura Boll |
First Address | Lancaster, PA 17602-2250 |
Second Address | Lancaster, PA 17602-2374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 12/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000243280 | UNISON (01) | PA |
101521533 | (05) | PA |
1565991 | GATEWAY (01) | PA |
209146 | HEALTH AMERICA (01) | PA |
50082771 | CAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL (01) | PA |