Provider Demographics
NPI:1508387929
Name:LEACH, LORI ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:LEACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:ZELAZNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 DUNLIN CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-8335
Mailing Address - Country:US
Mailing Address - Phone:717-579-9355
Mailing Address - Fax:
Practice Address - Street 1:400 PINE GROVE CMNS
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5161
Practice Address - Country:US
Practice Address - Phone:717-755-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017628363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care